Apparatus and system for rule based visualization of digital breast tomosynthesis  and other volumetric images

ABSTRACT

The invention provides, in some aspects, a system for implementing a rule derived basis to display volumetric image sets. In various embodiments of the invention, the selection of the images to be displayed, the generation of the 3-D volumetric image from measured 2-D images including the rendering parameters and styles, the choice of viewing directions and 2-D projection images based on the viewing directions, the layout of the projection images, and the formation of a video can be determined using a rule derived basis. In an embodiment of the present invention, the user is presented with sequential images making up a video displayed based on their preferences without having to first manually adjust parameters. The present invention allows for novel ways of viewing such images to detect microcalcifications and obstructions when reviewing Digital Breast Tomosynthesis and other volumetric mammography images.

PRIORITY CLAIM

This application is a continuation of (1) U.S. application Ser. No.16/985,986 entitled Method and System for Rule Based Visualizing DigitalBreast Tomosynthesis and Other Volumetric Images, filed Aug. 5, 2020,which claims priority to and is a continuation of (2) U.S. applicationSer. No. 16/531,413 entitled Method and System for Rule BasedVisualizing Digital Breast Tomosynthesis and Other Volumetric Images,filed Aug. 5, 2019, which issued as U.S. Pat. No. 10,820,877, whichclaims priority to and is a continuation of (3) U.S. application Ser.No. 16/049,801 entitled Method and System for Rule Based VisualizingDigital Breast Tomosynthesis and Other Volumetric Images, filed Jul. 30,2018, which issued as U.S. Pat. No. 10,631,812, which claims priority toand is a continuation of (4) U.S. application Ser. No. 15/220,325entitled Method and System for Rule Based Visualizing Digital BreastTomosynthesis and Other Volumetric Images, filed Jul. 25, 2016, whichissued as U.S. Pat. No. 10,070,839, which claims priority to and is acontinuation in part of (5) U.S. application Ser. No. 14/611,163 filedJan. 30, 2015, which issued as U.S. Pat. No. 9,524,577 which is acontinuation of (6) U.S. application Ser. No. 13/831,975 filed Mar. 13,2013, which issued as U.S. Pat. No. 8,976,190, where (4) also claimspriority to (7) U.S. Provisional application No. 62/197,956 filed Jul.28, 2015. The specification and drawings of (1)-(7) are herein expresslyincorporated by reference in their entireties and for all purposes.

FIELD OF INVENTION

The invention pertains to rule based ways of viewing volumetric imagesused for medical diagnosis.

BACKGROUND OF THE INVENTION

In order to diagnose a traditional X-Ray examination, the images printedon films would be ‘hung’ in front of a light box. For multi-imageexaminations, as well as for comparison with priors, the ‘hanging’ wouldoften follow a specific protocol. For example, a particular organizationor doctor may choose for a two-view chest X-Ray with a two-view priorexam, that the films be hung from left to right as follows: Frontal viewof current examination, lateral view of current examination, frontalview of prior examination, lateral view of prior examination. Incontrast, the doctor may hang mammography exams with the correspondingviews of current and prior next to each other, if that was moreappropriate for the diagnostic workflow in that case. Thus, theorganization or doctor developed a traditional ‘Hanging Protocol’.Currently, the film and the light box are often being replaced bycomputer systems, called PACS (Picture Archiving and CommunicationSystem). PACS systems can mimic the Hanging Protocols.

Traditional X-Ray examinations typically produce one or a small numberof single two dimensional (2D) images. In contrast, the more advancedimaging modalities such as Computer Tomography (CT), Magnetic ResonanceImaging (MRI) or Positron Emission Tomography (PET) can produce dozensof series, each consisting of a hundred or more images. It is possibleand not uncommon to review images from these advanced modalities in thesame manner as traditional X-Ray images, i.e., by hanging the individualimages side-by-side, either on a light-box or using a PACS system.

Volumetric images play an increasingly important role in medicaldiagnosis including cancer treatments such as site directed chemotherapyand radiology. Volumetric images are being generated by a multitude ofdifferent devices, including Magnetic Resonance Imaging (MRI) scanners,see for example Nuclear magnetic resonance imaging apparatus, U.S. Pat.No. 4,534,358, or Computed Tomography (CT) scanners, see for examplePatients' support installation for a tomographic X-ray apparatus, U.S.Pat. No. 3,974,388, or certain C-Arm devices, see for example C-Armcomputerized tomography system, U.S. Patent Application Publication No.2010/0284601.

A certain class of these modalities, such as the CT scanner computes thevolumetric images from a series of 2D projections from different angles,see for example (i) Methods and Apparatus for Reconstruction of 3D ImageVolumes From Projection Images, U.S. Pat. No. 7,876,944; (ii) Method ofReconstructing Computer Tomography (CT) Volumes Suitable for Executionon Commodity Central Processing Units (CPUS) and Graphics Processors,and Apparatus Operating in Accordance with those Methods, U.S. Pat. No.7,778,392 and (iii) Method of Reconstructing Computer Tomography (CT)Volumes Suitable for Execution on Commodity Central Processing Units(CPUS) and Graphics Processors, and Apparatus Operating in Accordancewith those Methods, U.S. Pat. No. 8,107,592, which references (i)-(iii)are herein expressly incorporated by reference in their entireties.

A recent advance in the field is the development of a Digital BreastTomo synthesis (DBT) scanner which generates volumetric mammographyimages, see for example Integrated multi-mode mammography/tomosynthesisx-ray system and method, U.S. Pat. No. 7,869,563, which is hereinexpressly incorporated by reference in its entirety Similar to CT orC-Arm devices, the DBT devices acquire a number of 2D X-Ray images, or2D projections, from different angles. From these projections avolumetric image is computed

SUMMARY OF THE INVENTION

The invention pertains to digital data processing and, moreparticularly, by way of example, to the visualization of image data.Three dimensional (3D) and four dimensional (4D) image data is routinelyacquired with CT, MRI, PET, confocal microscopes, 3D ultrasound devices,and other imaging devices. The medical imaging market is just oneexample of a market that uses these devices. The visualization of imagedata market is growing rapidly, with new CT scanners collecting largeramounts of data more quickly than previous generation CT scanners. Theinvention has application to areas including medical imaging,atmospheric studies, astrophysics and geophysics.

With the rapid increase in the amounts and types of information that canbe acquired using imaging technology, we have identified an advantage inpresenting volumetric image-based information in a form that can be usedby a physician or diagnostician. Namely, although there may be manydifferent types of image data, the forms, formats, integration, anddisplay of relevant information can be optimized for diagnosis.

In an embodiment of the present invention, a method for displayingvolumetric images comprises computing a projection image using a viewingdirection, displaying the projection image and then varying theprojection image by varying the viewing direction. In an embodiment ofthe present invention, the viewing direction can be varied based on aperiodic continuous mathematical function. In an embodiment of thepresent invention, a graphics processing unit (GPU) can be used tocompute the projection image and bricking can be used to accelerate thecomputation of the projection images. In another embodiment of thepresent invention, a sequence of projections covering one period can berendered, cached and then played back one or more times, where therendering is carried out on a server and the caching and play back iscarried out on a client computer. A render server program is describedin U.S. application Ser. No. 13/831,967, entitled ‘Multi-User Mult-GPURender Server Apparatus and Methods’, which was filed Mar. 15, 2013 isherein expressly incorporated by reference in its entirety. A rule basedrender server program is described in ‘Method and System for Rule-BasedDisplay of Sets of Images’ which issued as U.S. Pat. No. 8,976,190 onMar. 10, 2015, and is herein expressly incorporated by reference in itsentirety. In an alternative embodiment of the present invention, theviewing direction can be varied based on user input. In a differentembodiment of the present invention, a system that displays two or morevolumetric images by computing a projection image of each of thevolumetric images, using the same viewing direction v for eachvolumetric image, displaying each projection images, and varying theprojection image by varying the viewing direction, where the variedviewing direction is changed in the same way for each of theprojections. In an embodiment of the present invention, the volumetricimages are computed from a number of 2D X-Ray images, or 2D projections,from different angles generated by a DBT device. In an embodiment of thepresent invention, volumetric mammography images are displayed. In analternative embodiment of the present invention, volumetric images arecomputed from a number of 2D X-Ray images generated by angiography. Inan embodiment of the present invention, the volumetric cerebralangiography images of the human brain are displayed. In anotheralternative embodiment of the present invention, volumetric images arecomputed from a confocal microscope using antibody staining. In anembodiment of the present invention, volumetric cell tissue generated bythe confocal microscope is displayed.

These and other aspects of the invention are evident in the drawings andin the description that follows

BRIEF DESCRIPTION OF THE DRAWINGS

This invention is described with respect to specific embodimentsthereof. Additional features can be appreciated from the Figures inwhich:

FIG. 1A shows the specimen imaged using an X-Ray source from twopositions spanning an angular range;

FIG. 1B shows the specimen imaged using an X-Ray source and an X-Raydetector from a multitude of positions. The positions span a certainangular range that is defined by the physical constraints of the machineand the patient's position;

FIG. 2 illustrates the calculation of a projection P from the volumetricimage I, where the projection is defined by the viewing direction v,which defines the Projection plane, according to an embodiment of theinvention;

FIG. 3A shows a specimen with two areas of increased density, accordingto an embodiment of the invention;

FIG. 3B shows the two areas in FIG. 3A projected to the same spot in theprojection Image, according to an embodiment of the invention;

FIG. 3C shows the two areas in FIG. 3A projected to different spots inthe projection Image, according to an embodiment of the invention;

FIG. 4 shows how only a subset of the acquisition volume is covered bythe specimen, while other areas (hatched) only contain backgroundpixels, according to an embodiment of the invention;

FIG. 5 shows the volume subdivided into sub-volumes, according to anembodiment of the invention;

FIG. 6 illustrates the dynamic variation of the viewing direction vaccording to Equation 2, according to an embodiment of the invention;

FIG. 7A shows an artists impression of an image of a human breastcomputed from a number of images recreated from a specific angle where amicro calcification is occluded by denser breast tissue, according to anembodiment of the invention;

FIG. 7B shows an atrists impression of an image of a human breast takenfrom a different angle to that shown in FIG. 7A, where the microcalcification is visible and not occluded by the denser breast tissue,according to an embodiment of the invention;

FIG. 8A shows an artists impression of a screen dump of a video image atapproximately the two (2) second time point, where the video shows adynamic comparison of a human breast computed from a number of imagesrecreated as the viewing direction is changed, where micro calcificationoccluded by denser breast tissue can be revealed, according to anembodiment of the invention;

FIG. 8B shows an artists impression of a screen dump of a video image atapproximately the five (5) second time point, where the video shows adynamic comparison of a human breast computed from a number of imagesrecreated as the viewing direction is changed, where micro calcificationoccluded by denser breast tissue can be revealed, according to anembodiment of the invention;

FIG. 8C shows an artists impression of a screen dump of a video image atapproximately the nine (9) second time point, where the video shows adynamic comparison of a human breast computed from a number of imagesrecreated as the viewing direction is changed, where micro calcificationoccluded by denser breast tissue can be revealed, according to anembodiment of the invention;

FIG. 8D shows an artists impression of a screen dump of a video image atapproximately the twelve (12) second time point, where the video shows adynamic comparison of a human breast computed from a number of imagesrecreated as the viewing direction is changed, where micro calcificationoccluded by denser breast tissue can be revealed, according to anembodiment of the invention;

FIG. 9A shows the artists impression of a screen dump of a video imageat at approximately the five (5) second time point shown in FIG. 8B,according to an embodiment of the invention;

FIG. 9B shows the artists impression of a screen dump of a video imageat approximately nine (9) second time point shown in FIG. 8C, accordingto an embodiment of the invention;

FIG. 10 depicts a flow chart showing the steps of applying various rulesto the selected Study, according to an embodiment of the invention;

FIG. 11 depicts the resulting display for an example study, according toan embodiment of the invention;

FIG. 12A shows an example of a user interface to specify rules includinga dialog box to configure Study Selection rules applied to a prior chestCR, according to an embodiment of the invention;

FIG. 12B shows an example of a user interface to specify rules includinga dialog box to configure Study Selection rules applied to a prior leftbreast mammogram, according to an embodiment of the invention;

FIG. 13A shows the image of a human breast represented in FIG. 7A,according to an embodiment of the invention;

FIG. 13B shows the image of the human breast taken from a differentangle to that shown in FIG. 13A, represented in FIG. 7B, according to anembodiment of the invention;

FIG. 14A shows a screen dump from the mp3 video at approximately the two(2) second time point, represented in FIG. 8A, according to anembodiment of the invention;

FIG. 14B shows a screen dump from the mp3 video at approximately thefive (5) second time point, represented in FIG. 8B, according to anembodiment of the invention;

FIG. 14C shows a screen dump from the mp3 video at approximately thenine (9) second time point, represented in FIG. 8C, according to anembodiment of the invention;

FIG. 14D shows a screen dump from the mp3 video at approximately thetwelve (12) second time point, represented in FIG. 8D, according to anembodiment of the invention;

FIG. 15A shows the screen dump from the mp3 video at approximately thefive (5) second time point, as represented in FIG. 9A, according to anembodiment of the invention; and

FIG. 15B shows the screen dump from the mp3 video at approximately thenine (9) second time point, as represented in FIG. 9B, according to anembodiment of the invention

DETAILED DESCRIPTION OF THE INVENTION Definitions

The transitional term “comprising” is synonymous with “including,”“containing,” or “characterized by,” is inclusive or open-ended and doesnot exclude additional, unrecited elements or method steps.

The transitional phrase “consisting of” excludes any element, step, oringredient not specified in the claim, but does not exclude additionalcomponents or steps that are unrelated to the invention such asimpurities ordinarily associated with a composition.

The transitional phrase “consisting essentially of” limits the scope ofa claim to the specified materials or steps and those that do notmaterially affect the basic and novel characteristic(s) of the claimedinvention.

The term ‘bandwidth’ and ‘send bandwidth’ refer to various bit-ratemeasures, representing the available or consumed data communicationresources expressed in bits per second or multiples of it.

The phrase ‘adaptive bandwidth management’ means methods thatcontinuously adjust the amount of data that is sent into a network pertime in order to avoid or reduce network congestion and transfer delay.

The term ‘client-server’ refers to a computer system that selectivelyshares its resources with ‘clients’. A ‘client’ is a computer orcomputer program that initiates contact with a ‘client-server’ or‘server’ in order to make use of the server resources. A client-servercan be especially useful to undertake volume rendering tasks. Such aserver can have one or more graphics processing units. Further, bysharing the server's computer resources, multiple clients can access anduse the server resources at the same time. Because a computer does alimited amount of work at any moment, a time-sharing system must quicklyprioritize its tasks to accommodate the clients. Clients and serversexchange messages in a request-response messaging pattern: The clientsends a request, and the server returns one or multiple responses,synchronously or asynchronously.

The term ‘video’ means the display of three (3) or more 2-D projectionimages where there is a time delay between the first 2-D projectionimage and a second 2-D projection image and a time delay between thesecond 2-D projection image and a third 2-D projection image. A videomay be displayed using a number of formats including avi, fly, H.262,H.263, H.264, m4v, mov, MPEG-1, MPEG-1 Part 2, MPEG-2, MPEG-4 Part 2,nsv, ogv, roq, vp6, vp8, vp9, webm, and wmv.

The phrase ‘host computer’ means a server or other processor withassociated memory. In an embodiment of the invention, a host computer isenabled to provide measured 2-D projection images to a client.

The term ‘caching’ means storing in memory. A generated projection imagefrom a volumetric image can be cached in one or both a client associatedmemory and a server associated memory, where the memory can be accessedrapidly by either the client processor or the server processorrespectively.

The phrase ‘measured 2-D projection image’ means a two-dimensional (2-D)scan of biological tissue produced by forward-projection orback-projection of medical imaging equipment as described in U.S. Pat.No. 8,107,592 to A. Berman, and U.S. Pat. No. 7,876,944 to D Stalling etal.

The phrase ‘volumetric image’ refers to a three-dimensional (3-D)representation reconstructed from the data produced from a series ofmeasured 2-D projection images or other 2-D representations of a tissue,an organ or an entity.

The term ‘reconstruction’ means generating a 3-D volumetric image basedon a plurality of measured 2-D projection images. The phrase‘reconstruction of a volumetric image’ means calculating a 3-Dvolumetric image based on a plurality of measured 2-D projection images.

The term ‘generated’ means constructing one or more generated 2-Dprojection images from a 3-D volumetric image. The phrase ‘generating animage’ or means ‘generating a plurality of images’ means constructingone or more generated 2-D projection images from a 3-D volumetric image.In an embodiment of the invention, the one or more generated 2-Dprojection images can be generated at different viewing directions.

The phrase ‘viewing direction’ means the line constructed passingthrough a viewing position to an object. As the designated positionchanges, the viewing direction changes. As shown in FIG. 1A a firstviewing direction 111 is generated by the line between position 110 andthe object 105. A second viewing direction 116 is generated by the linebetween position 115 and the object 105. The angle (θ) between the firstviewing direction 111 and the second viewing direction 112 increasesfrom 0 to θ. The smallest viewing direction is when the angle=0. Thelargest viewing direction is when the angle=θ.

The phrase ‘equivalent viewing direction’ means the same viewingdirection in the absence of physiologic changes in the tissue or anequivalent viewing direction when physiologic changes have occurred or acomparable tissue is utilized, where the equivalent viewing directioncan compensate for changes in the tissue in the body with time and/orcan compensate for the symmetry and asymmetry of different tissue in thebody. The equivalent viewing direction can be used to ascertain thepresence or absence of physiologic changes in the tissue with time, orwhen physiologic changes have occurred based on the inspection of acomparable tissue. The equivalent viewing direction can compensate forchanges in the tissue in the body with time and/or can compensate forthe symmetry and asymmetry of viewing projection images of differenttissues in the body.

The phrase ‘improves the visual clarity of identification’ means aprocess or technique that compares or changes one or more projectionimages to allow an obstruction including a micro calcification to beidentified in the one or more projection images.

The term ‘Study’ will be used to refer to the set of images produced byan examination. A Study consists of one or more images. The images canbe grouped into one or more image series. Each image, each series, andthe whole Study can have different parameters attached. For medicalimages these can be defined by the Digital Imaging and Communication inMedicine (DICOM) standard.

The phrase ‘Hanging Protocol’ will be used to refer to specificconventions how X-Ray films are arranged (hung) at a light box.

The phrase ‘Display Protocol’ will be used to refer to the way imagesare displayed in a computer system, specifically the selection of theimages to be displayed, the layout of the images, as well as therendering parameters and styles.

The term ‘Viewport’ will be used to refer to the logical part of thescreen on the client computer in which a particular View is displayed,for example the user interface on the client computer can contain fourrectangular Viewports 1160 of which three show a frontal, left, andbottom view respectively of a particular data, while the fourth viewermight show a 2D cross section through the same or a different data set.

The phrase ‘Sets of Images’ or ‘Image Set’ will be used to refer to oneor more images, selected based on the rules.

The phrase ‘Study Selection Rules’ will be used to refer to the rulesused to select the studies to be displayed.

The phrase ‘Protocol Selection Rules’ will be used to refer to the rulesused to select the layout of the images to be displayed.

The phrase ‘Image Set Rules’ will be used to refer to the rules used toform Image Sets 1165 from the images of one or more Study by applyingselection, sorting, and breaking rules.

The phrase ‘Style Rules’ will be used to refer to the rules to determinewhich rendering type, rendering style, and rendering parameters are usedfor a particular Image Set 1165 in a particular viewer.

The phrase ‘Volume Rendering’ will be used to refer to Volume Renderingtechniques including shaded Volume Rendering techniques, maximumintensity projection (MIP), oblique slicing or multi-planar reformats(MPR), axial/sagittal and coronal slice display, and thick slices (alsocalled slabs). In medical imaging, for example, Volume Rendering is usedto display 3D images from 3D image data sets, where a typical 3D imagedata set is a large number of 2D slice images acquired by a CT or MRIscanner and stored in a data structure.

The terms ‘brick’ or ‘bricking’ mean partitioning a 3D image or aportion of the 3D image. Bricking is an iterative process involvingdetermining the intensity of pixels in the 2D image based on the rulethat all points in the 3D image data that are required for evaluatingthe intensities of the sample points along a ray passing through a brickare located within that brick. That is in an imaging apparatus having aCPU and a GPU with a plurality of programmable vertex shaders coupled toa plurality of programmable pixel shaders, the CPU partitions the 3Dimage into a plurality ‘bricks’ based on the vertex shaders and pixelshaders determining the intensities of one or more pixels in the 2Dimage as an iterative function of intensities of sample points in one ormore bricks in the 3D image through which viewing rays associated withthose pixels are passed, and where any two adjacent bricks preferablyhave a sufficient overlap such that all points in the 3D image data thatare required for evaluating the intensities of the sample points along aray passing through a brick are located within that brick.

The term ‘display’ means in the context of aspects and embodimentsdisclosed herein and refers in the usual and customary sense to physicalrepresentation of data e.g. a printed page or an electronicrepresentation on a visual display monitor, a cathode ray oscilloscope,a liquid crystal display, a nixie tube, a light emitting diode display,a plasma display and the like. The display of sensitive information canbe anonymized as described in U.S. patent application Ser. No.15/218,993 titled ‘Method and Apparatus for Anonymized Display and DataExport’ filed Jul. 25, 2016 inventors D. Stalling et al., thespecification and drawings of which are herein expressly incorporated byreference in their entirety.

The terms ‘view’ or ‘viewing’ mean a display of a 3D or 2D image.

The phrases ‘viewing position’ or ‘viewing ray’ refer to a display of a3D or 2D image as observed from the viewing position or along a linedefined by the viewing ray.

The term ‘identifies’ refers to a 3D or 2D image corresponding to a viewthat is displayed and/or compared with other views that reveals or moreclearly elucidates a microcalcification or obstruction through one ormore processes selected from the group consisting of: observation by thehuman eye, identification by a segmentation algorithm, identification bya bricking algorithm.

The term ‘microcalcification’ refers to small deposits of calciumtypically seen in a breast mammogram which depending on shape, number,pattern and/or relative position can be used as an early sign of breastcancer and/or presenting sign of breast cancer.

The term ‘obstruction’ means a filling defect or other ductalabnormality, such as ductal ectasia, fibrocystic changes or a ductalirregularity such as can be observed with ductography of the breastincluding galactography and ductogalactography.

In the following description, various aspects of the present inventionwill be described. However, it will be apparent to those skilled in theart that the present invention may be practiced with only some or allaspects of the present invention. For purposes of explanation, specificnumbers, materials, and configurations are set forth in order to providea thorough understanding of the present invention. However, it will beapparent to one skilled in the art that the present invention may bepracticed without the specific details. In other instances, well-knownfeatures are omitted or simplified in order not to obscure the presentinvention.

Parts of the description will be presented in data processing terms,such as data, selection, retrieval, generation, and so forth, consistentwith the manner commonly employed by those skilled in the art to conveythe substance of their work to others skilled in the art. As is wellunderstood by those skilled in the art, these quantities (data,selection, retrieval, generation) take the form of electrical, magnetic,or optical signals capable of being stored, transferred, combined, andotherwise manipulated through electrical, optical, and/or biologicalcomponents of a processor and its subsystems.

Various operations will be described as multiple discrete steps in turn,in a manner that is most helpful in understanding the present invention;however, the order of description should not be construed as to implythat these operations are necessarily order dependent.

Various embodiments will be illustrated in terms of exemplary classesand/or objects in an object-oriented programming paradigm. It will beapparent to one skilled in the art that the present invention can bepracticed using any number of different classes/objects, not merelythose included here for illustrative purposes. Furthermore, it will alsobe apparent that the present invention is not limited to any particularsoftware programming language or programming paradigm.

Receiving a Volumetric Image.

A computed tomography (CT) scan can generate many 2-D images taken fromdifferent angles around a scanned object to produce cross-sectional(tomographic) images (‘virtual slices’) of the scanned object.Alternatively, positron emission tomography (PET), single photonemission computed tomography (SPECT), computer assisted tomography (CAT)scanners or tomosynthesis systems can produce ‘measured projectionimages’. These measured 2-D projection images can be used to reconstructa ‘volumetric image’, where the virtual slices form a volumetric imageor 3-D image of the scanned object. The phrase ‘volumetric image’ refersto a 3-D representation reconstructed from the data produced byforward-projecting or back-projecting medical imaging equipment.Measured projection images can be measured by medical technologists, andcan be used to reconstruct a volumetric image and then the volumetricimage can be received by a physician in order to diagnose a patient.

In an embodiment of the invention, using the reconstructed 3-D image itis possible to form a generated 2-D projection image, that is, arepresentation can be generated from a volumetric image by identifying apoint source at a distinct focus and thereby a ‘projection direction’through the volume to a plane at which the respective generated 2-Dprojection image can be formed, as described in U.S. patent applicationSer. No. 15/218,972 titled ‘Apparatus and Method for Visualizing DigitalBreast Tomosynthesis and Other Volumetric Images’ inventors M.Westerhoff et al., filed Jul. 25, 2016, the specification and drawingsof which are herein expressly incorporated by reference in theirentirety.

Computing a Plurality of Projection Images

One or more generated 2-D projection images can be generated from avolumetric image. Computing a plurality of generated 2-D projectionimages of the volumetric image using a plurality of viewing directionsbetween a first viewing direction and a second viewing direction can beused to produce generated 2-D projection images required by a physicianbut otherwise not revealed by a measured 2-D projection image.Alternatively, by generating a plurality of generated 2-D projectionimages, a dynamic view of the volumetric image can be generated, whichallows for better diagnosis than a single or static measured 2-Dprojection image or a single or static generated 2-D projection image.

Comparing a First Projection Image a Second Projection Image

The phrase ‘time comparison’ means comparing a projection image obtainedat a specific viewing direction with an earlier in time projection imageof a tissue obtained at an equivalent viewing direction of the sametissue. In an embodiment of the invention, a time comparison comparesone or more projection images of a right breast with one or moreprojection images of the same right breast measured at an earlier timepoint, where the projection images are generated at equivalent viewingdirections. In an embodiment of the invention, a time comparisoncompares one or more measured 2-D projection images of a right breastwith one or more generated 2-D projection images of the same rightbreast generated from a volumetric image reconstructed from a pluralityof measured 2-D projection images from an earlier time point, where theprojection images are generated at equivalent viewing directions. In analternative embodiment of the invention, a time comparison compares oneor more generated 2-D projection images of a right breast with one ormore measured 2-D projection images of the same right breast measured atan earlier time point, where the projection images are generated atequivalent viewing directions.

The phrase ‘structural comparison’ means comparing a projection imageobtained at a specific viewing direction with a projection image of atissue obtained at an equivalent viewing direction of a different butcomparable tissue. In an embodiment of the invention, a structuralcomparison compares one or more projection images of a right breast withone or more projection images of a left breast both viewed at equivalentviewing directions. In an embodiment of the invention, a structuralcomparison compares one or more generated 2-D projection images of aright breast with one or more generated 2-D projection images of a leftbreast, where each of the generated 2-D projection images are viewed atequivalent viewing directions. In an alternative embodiment of theinvention, a structural comparison compares one or more measured 2-Dprojection images of a right breast with one or more generated 2-Dprojection images of a left breast, where each of the measured andgenerated 2-D projection images are viewed at equivalent viewingdirections. In another embodiment of the invention, a structuralcomparison compares one or more generated 2-D projection images of aright breast with one or more measured 2-D projection images of a leftbreast, where each of the measured and generated 2-D projection imagesare viewed at equivalent viewing directions.

The phrase ‘dynamic comparison’ means comparing a series of projectionimages obtained at a variety of viewing directions. In an embodiment ofthe invention, a dynamic comparison compares one or more DBT projectionimages of a right breast that change in time as the viewing direction isscanned as a video. In an embodiment of the invention, the change inviewing direction can adjust for the type of tissue being scanned.

The phrase ‘visual comparison’ means time comparing, structurallycomparing, and/or dynamically comparing one or more projection imageswith the naked eye.

The phrase ‘direct comparison’ means one or more of time comparing,structurally comparing, and dynamically comparing one or more projectionimages using a computer to analyze changes in the intensity density of avoxel matrix represented by the projection images. In an embodiment ofthe invention, one or more generated 2-D projection images are comparedwith one or more measured 2-D projection images using one or more oftime comparing, structurally comparing, and dynamically comparing,wherein a computer is used to analyze changes in the intensity densityof a voxel matrix represented by the one or more generated 2-Dprojection images and the one or more measured 2-D projection images.

A first viewing direction 111 corresponds with the line between position110 and the object 105. A second viewing direction 116 corresponds withline between position 115 and the object 105 (see FIG. 1A). Theincrement 112 is the angle between the first viewing direction 111 andthe second viewing direction 112 (see FIG. 1A). By selecting a firstviewing direction, a first generated 2-D projection image can be formed.Similarly, selecting a second viewing direction allows a secondgenerated 2-D projection image at the second viewing direction to beformed. In an embodiment of the invention a first generated 2-Dprojection image can be dynamically compared with one or more secondgenerated 2-D projection images. In an alternative embodiment of theinvention a measured 2-D projection image can be dynamically comparedwith one or more generated 2-D projection images. In an alternativeembodiment of the invention, a first projection image can be timecompared with a second projection image measured at an earlier time. Inanother embodiment of the invention, a generated 2-D projection imagecan be time compared with a measured 2-D projection image measured at anearlier time. In another embodiment of the invention, a first projectionimage can be structurally compared with a second projection image of acontrol tissue. In another embodiment of the invention, a generated 2-Dprojection image can be structurally compared with a measured 2-Dprojection image of a control tissue. In an embodiment of the invention,a density map for the first projection image is visually compared with adensity map of the second projection image. In an embodiment of theinvention, a density map for a generated 2-D projection image isvisually compared with a density map of a measured 2-D projection image.In an alternative embodiment of the invention, a computer program isused to directly compare the density map for the first projection imagewith a density map of the second projection image. In anotheralternative embodiment of the invention, a computer program is used todirectly compare the density map for a generated 2-D projection imagewith a density map of a measured 2-D projection image.

Volume Rendering

Volume rendering, or reconstructing a volume, includes a variety ofstandard visualization methods including volume rendering techniques(VRT), shaded volume rendering techniques (sVRT), maximum intensityprojection (MIP), oblique slicing or multiplanar reformats (MPR),axial/sagittal and coronal slice display, and thick slices (also calledslabs). Within the scope of the invention, other methods and apparatusof forward-projection and back-projection can be used for generating aseries of measured 2-D projection images with which to reconstruct 3-Dvolumetric image representations, as described in ‘Client-ServerVisualization System with Hybrid Data Processing’ which issued as U.S.Pat. No. 9,019,287 Apr. 28, 2015, and which is herein expresslyincorporated by reference in its entirety.

In an embodiment of the invention, a computer chip, chip set, computerboard and/or computer processor can be configured as a ‘graphicsprocessing unit’ (GPU) to perform volume rendering and or to generateone or more reconstructed 2-D projection views from a volumetric image.In an embodiment of the invention, volume rendering includesinitializing to arbitrary values the volume density distribution in avoxel matrix, iteratively estimating and comparing with a measuredprojection, and then correcting each pixel based on the comparison asdescribed in U.S. Pat. No. 7,876,944.

Intensity Values.

Image segmentation is an automated technique that facilitatesdistinguishing objects and other features in digital images. Thetechnique can be used, for example, to simplify digitized images so thatthey can be more readily interpreted by computers (e.g., image analysissoftware) and/or by their users. An image can be made up of pixelscontaining a wide range of undifferentiated intensity values thatalthough, possibly recognizable to the human eye as skeletal bones anddigestive tract are largely uninterpretable by a computer. In anembodiment of the invention, a comparison between a first projectionimage with a second projection image that reveals an area of increasedintensity values in the second projection image can indicate that thesecond viewing direction which generated the second projection imagereveals an unobstructed projection image. In an alternative embodimentof the invention, a comparison between a generated 2-D projection imagewith a measured 2-D projection image that reveals an area of increaseddifferentiated intensity values in the measured 2-D projection image canindicate that the viewing direction which formed the generated 2-Dprojection image reveals an unobstructed viewing direction. In analternative embodiment of the invention, a comparison between a firstprojection image with a second projection image that reveals an area ofincreased differentiated intensity values in the second projection imagecan indicate that the second viewing direction which generated thesecond projection image reveals an increased clarity projection image,as described in U.S. Pat. No. 8,548,215, ‘Automatic Image Segmentationof a Volume by Comparing and Correlating Slice Histograms with anAnatomic Atlas of Average Histograms’ Oct. 1, 2013 and which is hereinexpressly incorporated by reference in its entirety. In an alternativeembodiment of the invention, a comparison between a generated 2-Dprojection image with a measured 2-D projection image that reveals anarea of increased differentiated intensity values in the measured 2-Dprojection image can indicate that the viewing direction which formedthe generated 2-D projection image reveals an advantageous viewingdirection.

Primary Study versus Secondary Study

A primary study is a study carried out at a specified time point. Asecondary study is a study carried out at a subsequent time point. In anembodiment of the invention, a computer chip, chip set, computer boardand/or computer processor can be configured as a ‘digita data processor’to perform volume rendering, to generate one or more projection viewsfrom a volume and or to compare two or more projection views. Thedigital data is generated by forward-projecting or back-projectingmedical imaging equipment used to generate measured projection images orother 2-D representations. In an embodiment of the invention, acomparison between a generated 2-D projection image from a secondarystudy with a generated 2-D projection image from a primary study thatreveals an area of increased differentiated intensity values can be usedto assess the development or changes occuring over time. In anembodiment of the invention, a comparison between a generated 2-Dprojection image from a secondary study with a measured 2-D projectionimage from a primary study that reveals an area of increaseddifferentiated intensity values in the measured 2-D projection image canindicate that the viewing direction which formed the generated 2-Dprojection image reveals an unobstructed viewing direction.

Overview

Due to the physical constraints of the acquisition setup, the possibleangular range of the acquisition is often limited. Typically the angularrange 112 is less than 180° in digital breast tomosynthesis (DBT) (seeFIG. 1A). For mathematical reasons, this results in volumetric imageswith a non-isotropic resolution. More precisely, the resolution in theplane perpendicular to the average projection direction is much higher,than the reconstructed resolution in the average direction of the X-Raybeam.

This aspect has to be taken into account when designing viewing methodsfor such images. Given the reconstructed volumetric image, in thefollowing the direction of the lowest resolution will be referred to asthe z-direction, or z. The vectors defining the average detectororientation, i.e. the plane with the highest resolution are denoted asx, and y. The x, y, and z directions are mutually perpendicular to eachother.

In order to display a volumetric image on a standard computer screen,which is two dimensional, a transformation has to be applied in order tocompute a 2-D representation of the volumetric image.

For DBT viewing, a slicing transformation can be used, where a singleslice perpendicular to the z-direction is shown on the screen. Typicallya user interface, such as a slider or text input field, allows the userto select which slice can be shown. In the following this will bereferred to as ‘xy-slicing’ or ‘slicing’. While xy-slicing is animportant viewing tool, it has some limitations. In particular it onlytakes into account a small subset of the information present in thevolumetric data set.

The present invention overcomes the limitation of using only a smallsubset of the information by using a projection method to incorporatethe entirety of the volumetric information. In an embodiment of thepresent invention, time is used as a third dimension to resolveambiguities in a comprehensible and intuitive way.

From the volumetric image a projection can be computed. Let

I: R³→R be the volumetric image.

Let v e R³ be a three dimensional vector defining a first viewingdirection.

Let i _(x) and i _(y) be two vectors spanning a projection planeperpendicular to v and perpendicular to each other.

Then a projection P(v,.) can be defined as follows:

P(v,.): R²→R

P(v,p)=max(I(r))|r e R³ where v dot i _(x) =p₁, v dot v _(y) =p₂ andP(v,.) is a 2D image that can be displayed on a computer screen usingstandard methods.

Displaying P(v,.) as defined above provides the user with additionaldiagnostic information as it takes into account the whole data set. Forexample if there was a lesion in the examined specimen and thevolumetric image was viewed using xy-slicing then that lesion would onlybe visible in a subset of the slices at or around the z-position of thelesion. If the wrong z-position was chosen, the lesion can be missed.Therefore the user would have to examine each slice to be certain therewas no lesion present, or alternatively risk overlooking a lesion. In anunexpected result, viewing a dynamic comparison in the form of a videocan allow the information to be quickly and efficiently compared.

FIG. 1A shows a specimen 105 imaged from two positions 110, 115 spanningan angular range 112 which generate viewing directions 111, 116respectively. FIG. 1B shows the principle of DBT. In FIG. 1B, thespecimen 105 (e.g. a human breast) can be imaged using an X-Ray sourceand an X-Ray detector from a multitude of positions that lie on the arcbeginning at position 110 and ending at position 115 and which aredetected at detector positions 120 and 125, respectively. The averageacquisition direction is indicated by the dotted line 130. The positionsspan a certain angular range that is defined by the physical constraintsof the machine and the patient's position. The z vector (z) 130 denotesthe middle projection direction in that angular range. FIG. 2illustrates the calculation of a projection P from the volumetric imageI, 235. The projection is defined by the viewing direction v 245, whichdefines the projection plane 240. In general v 245 is not necessarilyidentical to the average acquisition direction z 250. The two vectors i_(x) 252 and i _(y) 254 are the x-direction and y-direction of theprojection image P, respectively. The vectors i _(x) 252 and i _(y) 254are perpendicular to the viewing direction v 245. The vector i _(x) 252is perpendicular to the vector i _(y) 254, and can be chosen accordingto the users viewing preferences or automatically specified according toautomated rules, as described in more detail in ‘Method and System forRule-Based Display of Sets of Images’ issued as U.S. Pat. No. 8,976,190.Digital Imaging and Communication in Medicine (DICOM) parameters formaking rule based decisions include the time of generation of themeasured projection images, the type of tissue measured and whether thetissue has an equivalent control that can be used as a control. Forexample for mediolateral acquisition directions, the y-axis willtypically be chosen such that it aligns with the projection of thepatient's head-foot axis.

Instead, when looking at the projection image P(v,.), an area ofincreased density, such as a lesion or calcification will appear as abrighter spot, irrespective of its z-position, making it possible todetect in many cases. FIG. 7A shows an atrists impression of an image ofa human breast computed from a number of 2D X-Ray images produced by aDBT device taken from a specific angle where a micro calcification isoccluded by denser breast tissue. In FIG. 7A a region 774 is identified.FIG. 7B shows an atrists impression of an image of a human breast takenfrom a different angle to that shown in FIG. 7A. Comparison of FIG. 7Aand FIG. 7B show a micro calcification is visible in FIG. 7B when thetissue is not occluded by denser breast tissue. Unexpectedly, in FIG. 7Bthe region 774 which was identified in FIG. 7A shows a microcalcification is visible and not occluded by the denser breast tissue.

FIGS. 8A-8D show an artists impression of four (4) images which make uptime points in a mp3 video of a dynamic comparison of DBT of a rightbreast while the viewing direction changes, according to an embodimentof the invention. The mp3 video used to generate FIGS. 8A-8D had aduration of approximately 13 seconds. Unexpectedly, the mp3 video is anexcellent means of inspecting DBTs to identify micro calcifications.FIG. 8A shows the artists impression of a screen dump from the mp3 videoat approximately the two (2) second time point. FIG. 8B shows theartists impression of a screen dump from the mp3 video at approximatelythe five (5) second time point. FIG. 8C shows the artists impression ofa screen dump from the mp3 video at approximately the nine (9) secondtime point. FIG. 8D shows the artists impression of a screen dump fromthe mp3 video at approximately the twelve (12) second time point. Thedynamic comparison illustrates the differences between the intensity ofthe voxel matrix from which the projection image is calculated.Unexpectedly, when viewing the video a spot becomes apparent, which isshown in FIG. 8B and FIG. 8C but is not present in FIG. 8A or FIG. 8D.FIG. 9A shows an enlarged version of FIG. 8B, the artists impression ofthe screen dump from the mp3 video at approximately the five (5) secondtime point where the region 774 is identified. FIG. 9B shows an enlargedversion of FIG. 8C, the artists impression of the screen dump from themp3 video at approximately the nine (9) second time point where theregion 774 is again identified. The spot seen in FIG. 8B (FIG. 9A) andFIG. 8C (FIG. 9B) reduces in intensity between the observation in FIG.8B (FIG. 9A) and the observation in FIG. 8C (FIG. 9B). Unexpectedly, theemergence and dimunition of a relatively bright spot in the sameposition when viewing a video, can also be used to confirm amicrocalcification rather than an artifact of the imaging system. Thus,based on the mp3 video a microcalcification 774 jumps to the viewer'sattention by way of the nature of the dynamic comparison, as shown inthe difference between FIG. 8A where no microcalcification is presentand FIG. 8B (FIG. 9A) where the microcalcification, 774 is present.Viewing the mp3 video improves the visual clarity of identification of amicro calcification.

FIG. 13A shows the image of a human breast generated from a volumetricimage reconstructed from a number of 2D X-Ray images produced by a DBTdevice, where the generated 2-D projection image was formed at aspecific angle, where a micro calcification is occluded by denser breasttissue, as represented in FIG. 7A. FIG. 13B shows the generated 2-Dprojection image of the human breast formed from a different angle tothat shown in FIG. 13A, where the micro calcification is visible and notoccluded by the denser breast tissue, as represented in FIG. 7B. FIGS.14A-14D show four (4) images which make up time points in the mp3 videoof the dynamic comparison of the DBT of the right breast. FIG. 14A showsa screen dump from the mp3 video at a two (2) second time point, asrepresented in FIG. 8A. FIG. 14B shows a screen dump from the mp3 videoat the five (5) second time point, as represented in FIG. 8B. FIG. 14Cshows a screen dump from the mp3 video at the nine (9) second timepoint, as represented in FIG. 8C. FIG. 14D shows a screen dump from themp3 video at the twelve (12) second time point, as represented in FIG.8D. FIG. 15A shows an enlarged version of FIG. 14B, the screen dump fromthe mp3 video at the five (5) second time point where the region 774 isidentified, as represented in FIG. 9A. FIG. 15B shows an enlargedversion of FIG. 14C, the screen dump from the mp3 video at the nine (9)second time point where the region 774 is identified, as represented inFIG. 9B.

A draw-back of any projection method, is that there can be an occlusionor overlay effect. In the case of a maximum intensity projection asdefined above, consider the case where two (2) separate areas ofincreased density are at different z positions on approximately the sameviewing ray v. FIG. 3A shows a specimen 356 with two separate areas 353and 355 of increased density. In the projection they will appear as one,potentially larger spot. That is, for one viewing direction (v1) 358 thetwo separate areas 353 and 355 can be projected to the same spot in theprojection image (projection 1) shown in FIG. 3B.

In an embodiment of the present invention, this ambiguity can beresolved by making the projection dynamic. Instead of choosing a fixedviewing direction v, a dynamic viewing direction can be used. Using analternative viewing direction (v2) 360, the two separate areas 353 and355 project to different spots in the projection image, making itobvious that there are two areas of interest. FIG. 3C shows for thesecond viewing direction (v2) 360 the two separate areas 353 and 355 canbe projected to different spots in the generated 2-D projection image(projection 2).

In an alternative embodiment of the invention, different dynamicfunctions can be used to generate dynamic projection viewing directions.Given the non-isotropy of the input data mentioned above, the mostuseful dynamic functions are continuous periodic functions around the zdirection. Two non-limiting examples of dynamic functions include:

v(t)=normalize( z+A sin(ωt) x )  Equation 1

v(t)=normalize( z+A sin(ωt) x+A cos(ωt) y )  Equation 2

where normalize(v)=v/|v|; t: time; ω=2πf; f: frequency of the dynamicmovement and A: Amplitude of the dynamic movement, e.g. A=0.05.

In other embodiments of the invention, different alternative dynamicfunctions can be used to generate dynamic projection viewing directions.In an embodiment of the invention, a linear function can be used inwhich the angle can be changed linearly. In an alternative embodiment ofthe invention, a z direction can be chosen and either the x or the ydirection can be incremented. FIG. 6 illustrates the dynamic variationof the viewing direction v according to Equation 2. The viewingdirection at two different points v _(t1) 666 and v _(t2) 668 at time t₁and t₂ is shown, as well as the corresponding projection planesprojection plane (t₁) 670 and projection plane (t₂) 672. Over time theviewing direction v can be varied around the main acquisition directionz 130.

In another embodiment of the invention, the viewing direction can bedetermined by the user. In another alternative embodiment of theinvention, the viewing direction can be determined by the user with anappropriate input device, such as a mouse. In an embodiment of thepresent invention, let (m_(x1), m_(y1)) be the position of the mouse (orappropriate input device) at a starting time t₁. The starting time canthen be defined by a mouse click (or appropriate input device). In analternative embodiment of the present invention, the starting time canbe triggered by the user entering a certain window with the mouse (orappropriate input device), or other graphical or non graphical criteria.

Assuming the user is moving the mouse, let (m_(x2), m_(y2)) be theposition of the mouse (or appropriate input device) at time t₂. Lets_(width) and s_(height) be the width and height of the screen.

Then v(t2)=normalize (z+2 A x (m_(x2)−m_(x1))/s_(width)+2 A y(m_(y2)−m_(y1))/s_(height)) can be the interactively controlled viewingdirection at time t₂. A person of ordinary skill in the art willappreciate that alternative mappings from the mouse coordinates toviewing directions can be used. In various embodiments of the presentinvention, alternative input methods or devices can be used including, aslider, a trackball, a head tracking device or an eye tracking device.

The above projection is a maximum intensity projection. In various otherembodiments of the present invention, other projection functions can beused, including emission absorption models or minimum intensityprojections. The above projection is equivalent to an orthographicprojection, where a 3-D object is represented in two dimensions throughparallel projection, where all the projection lines are orthogonal tothe projection plane. A person of ordinary skill in the art willappreciate that alternative projections including perspectiveprojections can be used.

In an embodiment of the invention, an optimal viewing direction can beselected by comparing the resulting projection images at a plurality ofviewing directions. In an embodiment of the invention, the criterionused for determining the optimal viewing direction can be a viewingdirection that identifies an unobserved obstruction. In an alternativeembodiment of the invention, the criterion used for determining theoptimal viewing direction can be a viewing direction that improves thevisual clarity of an initial projection image. In another alternativeembodiment of the invention, the criterion used for determining theoptimal viewing direction can be a viewing direction that improves thevisual clarity of an improved projection image compared with an initialprojected image. In a different embodiment of the invention, thecriterion used for determining the optimal viewing direction can be aviewing direction that improves the visual clarity of identification ofan obstruction. In another different embodiment of the invention, thecriterion used for determining the optimal viewing direction can be aviewing direction that identifies an obstruction using directcomparison. In another embodiment of the invention, the criterion usedfor determining the optimal viewing direction can be a viewing directionthat improves the direct comparison clarity of an initial projectionimage. In an embodiment of the invention, the criterion used fordetermining the optimal viewing direction can be a viewing directionthat improves the direct comparison clarity of an improved projectionimage compared with an initial projected image. In another embodiment ofthe invention, the criterion used for determining the optimal viewingdirection can be a viewing direction that improves the direct comparisonclarity of identification of an obstruction.

Volumetric images in DBT are quite large data sets, as the xy-resolutionis an order of magnitude larger than for example a standard CT scan. Inorder to render such large images at interactive speeds graphicsprocessing units (GPU) can be utilized, see for example, U.S. Pat. No.8,189,002, ‘Methods and Apparatus for Visualizing Three-Dimensional andHigher-Dimensional Image Data Sets’ May 29, 2012 and which is hereinexpressly incorporated by reference in its entirety. In typical DBTimages, only a subset of the voxels of the volumetric image containtissue, while other voxels are background pixels that are irrelevant forthe diagnosis. In an embodiment of the present invention, by using athreshold segmentation these background pixels can be identified. FIG. 4shows how only a subset of the acquisition volume is covered by thespecimen 462, while other areas (hatched) 464 only contain backgroundpixels. These background pixels can be identified using thresholdsegmentation. FIG. 5 shows the volume can be subdivided intosub-volumes. In one embodiment of the invention, an octree decompositionscheme can be used for this subdivision. In another embodiment of theinvention, a binary space partitioning (BSP) scheme can be used for thesubdivision. A person with ordinary skills in the art will appreciatethat other subdivision schemes can be used. Sub-volumes that containonly background voxels (shown as hatched in FIG. 4 and FIG. 5) 464 canbe skipped during the rendering process. Sub-volumes 463 that containboth, background voxels and tissue voxels can be further sub-divideduntil a configured minimum size containing specimen 462 or background464 can be reached. In an embodiment of the invention, bricking can beused to display only those sub-volumes that are not background-only. Thetechnique of bricking for GPU based rendering is described in U.S. Pat.No. 8,189,002.

In an embodiment of the present invention, for the effective use ofdynamic projection images, a sufficiently high frame rate is required inorder to allow for a smooth rendering that appears natural to the user.This can be achieved in many cases by using GPU hardware combined withthe bricking technique.

In an alternative embodiment of the present invention, a periodicdynamic viewing direction function can be used, and a sequence ofprojections covering one full period (1/f) can be pre-rendered, and thenbe played back in a loop. In case of a client server visualizationsystem, the pre-rendered images can be computed on the server side andcached on the client side thereby making optimal use of the bandwidthand allowing for smooth playback even on slow networks.

In radiological diagnostics, comparison to prior images is relevant todetect change, e.g. tumor growth. In an embodiment of the presentinvention, a projection of a current image and a projection of thecorresponding prior image can be displayed side-by-side and used todetermine the change in tumor characteristics. The comparison caninclude the user visually comparing with the naked eye. The comparisoncan also be undertaken by a direct comparison program where equivalentviewing directions are used for the direct comparison. In variousembodiments of the present invention, the user can choose the samedynamic viewing direction function for both, the current and the priorimage, thereby allowing for direct comparison.

Another aspect of the invention is to combine the projection display ofthe volumetric image with conventional 2D mammograms or other X-Ray orradiological images, by dividing the available computer screens intovirtual view ports and using one or more of the virtual view ports todisplay the one or more projection images, and one or more of thevirtual viewports to display the other radiological images.

A method for displaying one or more optimal projection images generatedfrom a volumetric image comprising the steps of receiving the volumetricimage, computing a plurality of projection images of the volumetricimage using a plurality of viewing directions, where at least an initialprojection image of the plurality of projection images is computed usinga first viewing direction, where a second viewing direction of theplurality of viewing directions is not equal to the first viewingdirection, one or more of time comparing, structurally comparing anddynamically comparing the plurality of projection images to determineone or more optimal projection images and displaying the optimalprojection images.

A method for identifying one or more optimal projection images generatedfrom a volumetric image comprising the steps of receiving the volumetricimage, computing a plurality of projection images of the volumetricimage using a plurality of viewing directions, where at least an initialprojection image of the plurality of projection images is computed usinga first viewing direction, where a second viewing direction of theplurality of viewing directions is not equal to the first viewingdirection, and one or more of time comparing, structurally comparing anddynamically comparing the plurality of projection images to determineone or more optimal projection images.

A method for identifying one or more optimal projection images generatedfrom a volumetric image comprising the steps of receiving the volumetricimage, computing a plurality of projection images of the volumetricimage using a plurality of viewing directions, where at least an initialprojection image of the plurality of projection images is computed usinga first viewing direction, where a second viewing direction of theplurality of viewing directions is not equal to the first viewingdirection, and one or more of time comparing, structurally comparing anddynamically comparing the plurality of projection images to determineone or more optimal projection images, where the optimal viewingdirection is selected from the group consisting of a viewing directionthat identifies an unobserved obstruction, a viewing direction thatimproves the visual clarity of the first projection image, a viewingdirection that improves the visual clarity of the second projectionimage, a viewing direction that improves the visual clarity ofidentification of an obstruction, a viewing direction that identifies anobstruction using direct comparison, a viewing direction that increasesthe differentiated intensity values of the first projection image, aviewing direction that increases the differentiated intensity values ofthe second projection image, a viewing direction that improves thedirect comparison clarity of the first projection image, a viewingdirection that improves the direct comparison clarity of the secondprojection image, and a viewing direction that improves the directcomparison clarity of identification of an obstruction.

A method to determine one or more optimal projection images from avolumetric image comprising the steps of receiving a volumetric image,computing a plurality of projection images based on the volumetric imageusing a plurality of viewing directions, one or more of time comparing,structurally comparing and dynamically comparing the plurality ofprojection images to determine one or more optimal viewing directions,and correlating the optimal viewing directions with one or moreprojection images of the plurality of projection images to determine oneor more optimal projection images.

A method to determine one or more optimal projection images from avolumetric image comprising the steps of receiving a volumetric image,computing a plurality of projection images based on the volumetric imageusing a plurality of viewing directions, one or more of time comparing,structurally comparing and dynamically comparing the plurality ofprojection images to determine one or more optimal viewing directions,and correlating the optimal viewing directions with one or moreprojection images of the plurality of projection images to determine oneor more optimal projection images, where the optimal viewing directionis selected from the group consisting of a viewing direction thatidentifies an unobserved obstruction, a viewing direction that improvesthe visual clarity of the first projection image, a viewing directionthat improves the visual clarity of the second projection image, aviewing direction that improves the visual clarity of identification ofan obstruction, a viewing direction that identifies an obstruction usingdirect comparison, a viewing direction that improves the directcomparison clarity of the first projection image, a viewing directionthat improves the direct comparison clarity of the second projectionimage, and a viewing direction that improves the direct comparisonclarity of identification of an obstruction.

A method to determine one or more optimal projection images from avolumetric image comprising the steps of receiving a volumetric image,computing a plurality of projection images based on the volumetric imageusing a plurality of viewing directions, one or more of time comparing,structurally comparing and dynamically comparing the plurality ofprojection images to determine one or more optimal viewing directions,and correlating the optimal viewing directions with one or moreprojection images of the plurality of projection images to determine oneor more optimal projection images, where the volumetric image is a 3Dimage.

A method to determine one or more optimal projection images from avolumetric image comprising the steps of receiving a volumetric image,computing a plurality of projection images based on the volumetric imageusing a plurality of viewing directions, one or more of time comparing,structurally comparing and dynamically comparing the plurality ofprojection images to determine one or more optimal viewing directions,and correlating the optimal viewing directions with one or moreprojection images of the plurality of projection images to determine oneor more optimal projection images, where the plurality of projectionimages are 2D images.

A method to determine one or more optimal projection images from avolumetric image comprising the steps of receiving a volumetric image,computing a plurality of projection images based on the volumetric imageusing a plurality of viewing directions, one or more of time comparing,structurally comparing and dynamically comparing the plurality ofprojection images to determine one or more optimal viewing directions,and correlating the optimal viewing directions with one or moreprojection images of the plurality of projection images to determine oneor more optimal projection images, where at least one of the pluralityof viewing directions is determined using a periodic continuousmathematical function.

A method to determine one or more optimal projection images from avolumetric image comprising the steps of receiving a volumetric image,computing a plurality of projection images based on the volumetric imageusing a plurality of viewing directions, one or more of time comparing,structurally comparing and dynamically comparing the plurality ofprojection images to determine one or more optimal viewing directions,and correlating the optimal viewing directions with one or moreprojection images of the plurality of projection images to determine oneor more optimal projection images, where at least one of the pluralityof viewing directions is determined using a periodic continuousmathematical function, where the plurality of projection images is asequence of projections images spanning one period of the periodiccontinuous mathematical function.

A method to determine one or more optimal projection images from avolumetric image comprising the steps of receiving a volumetric image,computing a plurality of projection images based on the volumetric imageusing a plurality of viewing directions, one or more of time comparing,structurally comparing and dynamically comparing the plurality ofprojection images to determine one or more optimal viewing directions,and correlating the optimal viewing directions with one or moreprojection images of the plurality of projection images to determine oneor more optimal projection images, where at least one of the pluralityof viewing directions is determined using a periodic continuousmathematical function, where the plurality of projection images is asequence of projections images spanning one period of the periodiccontinuous mathematical function, further comprising rendering andcaching a sequence of projection images.

A method to determine one or more optimal projection images from avolumetric image comprising the steps of receiving a volumetric image,computing a plurality of projection images based on the volumetric imageusing a plurality of viewing directions, one or more of time comparing,structurally comparing and dynamically comparing the plurality ofprojection images to determine one or more optimal viewing directions,and correlating the optimal viewing directions with one or moreprojection images of the plurality of projection images to determine oneor more optimal projection images, where at least one of the pluralityof viewing directions is determined using a periodic continuousmathematical function, where the plurality of projection images is asequence of projections images spanning one period of the periodiccontinuous mathematical function, further comprising rendering andcaching a sequence of projection images, where the rendered and cachedsequence of projections are played back one or more times.

A method to determine one or more optimal projection images from avolumetric image comprising the steps of receiving a volumetric image,computing a plurality of projection images based on the volumetric imageusing a plurality of viewing directions, one or more of time comparing,structurally comparing and dynamically comparing the plurality ofprojection images to determine one or more optimal viewing directions,and correlating the optimal viewing directions with one or moreprojection images of the plurality of projection images to determine oneor more optimal projection images, where at least one of the pluralityof viewing directions is determined using a periodic continuousmathematical function, where the plurality of projection images is asequence of projections images spanning one period of the periodiccontinuous mathematical function, further comprising rendering andcaching a sequence of projection images, where the rendering is carriedout on a server and one or both the caching and play back is carried outon a client computer.

A method to determine one or more optimal projection images from avolumetric image comprising the steps of receiving a volumetric image,computing a plurality of projection images based on the volumetric imageusing a plurality of viewing directions, one or more of time comparing,structurally comparing and dynamically comparing the plurality ofprojection images to determine one or more optimal viewing directions,and correlating the optimal viewing directions with one or moreprojection images of the plurality of projection images to determine oneor more optimal projection images, where a graphics processing unit isused to compute one or more of the plurality of projection images.

A method to determine one or more optimal projection images from avolumetric image comprising the steps of receiving a volumetric image,computing a plurality of projection images based on the volumetric imageusing a plurality of viewing directions, one or more of time comparing,structurally comparing and dynamically comparing the plurality ofprojection images to determine one or more optimal viewing directions,and correlating the optimal viewing directions with one or moreprojection images of the plurality of projection images to determine oneor more optimal projection images, where a graphics processing unit isused to compute one or more of the plurality of projection images, wherebricking is used to accelerate computation of one or more of theplurality of projection images.

A method to determine one or more optimal projection images from avolumetric image comprising the steps of receiving a volumetric image,computing a plurality of projection images based on the volumetric imageusing a plurality of viewing directions, one or more of time comparing,structurally comparing and dynamically comparing the plurality ofprojection images to determine one or more optimal viewing directions,and correlating the optimal viewing directions with one or moreprojection images of the plurality of projection images to determine oneor more optimal projection images, where one or more of the plurality ofviewing directions is based on user input.

A method to determine one or more optimal projection images from avolumetric image comprising the steps of receiving a volumetric image,computing a plurality of projection images based on the volumetric imageusing a plurality of viewing directions, one or more of time comparing,structurally comparing and dynamically comparing the plurality ofprojection images to determine one or more optimal viewing directions,and correlating the optimal viewing directions with one or moreprojection images of the plurality of projection images to determine oneor more optimal projection images, further comprising visually comparingthe plurality of projection images.

A system that displays a first projection image and a second projectionimage of a volumetric image comprising computing a first projectionimage of the volumetric image using a first viewing direction, computinga second projection image of the volumetric image using a second viewingdirection, where the first viewing direction is not equal to the secondviewing direction, and displaying the first projection image and thesecond projection image.

A system that displays a first projection image and a second projectionimage of a volumetric image comprising computing a first projectionimage of the volumetric image using a first viewing direction, computinga second projection image of the volumetric image using a second viewingdirection, where the first viewing direction is not equal to the secondviewing direction, and displaying the first projection image and thesecond projection image, further comprising computing a third projectionimage using a third viewing direction, and displaying one or both thefirst projection image and the second projection image with the thirdprojection image.

A system that displays a first projection image and a second projectionimage of a volumetric image comprising computing a first projectionimage of the volumetric image using a first viewing direction, computinga second projection image of the volumetric image using a second viewingdirection, where the first viewing direction is not equal to the secondviewing direction, and displaying the first projection image and thesecond projection image, further comprising computing a third projectionimage using a third viewing direction, and displaying one or both thefirst projection image and the second projection image with the thirdprojection image, where one or both the second viewing direction and thethird viewing direction are determined using a periodic continuousmathematical function.

A system that compares a first projection image and a second projectionimage of a volumetric image comprising computing a first projectionimage of the volumetric image using a first viewing direction, computinga second projection image of the volumetric image using a second viewingdirection, and one or more of time comparing, structurally comparing anddynamically comparing the first projection image and the secondprojection image.

A system that compares a first projection image and a second projectionimage of a volumetric image comprising computing a first projectionimage of the volumetric image using a first viewing direction, computinga second projection image of the volumetric image using a second viewingdirection, and one or more of time comparing, structurally comparing anddynamically comparing the first projection image and the secondprojection image, further comprising computing a third projection imageusing a third viewing direction, and comparing one or both the firstprojection image and the second projection image with the thirdprojection image.

A system that compares a first projection image and a second projectionimage of a volumetric image comprising computing a first projectionimage of the volumetric image using a first viewing direction, computinga second projection image of the volumetric image using a second viewingdirection, and one or more of time comparing, structurally comparing anddynamically comparing the first projection image and the secondprojection image, further comprising computing a third projection imageusing a third viewing direction, and comparing one or both the firstprojection image and the second projection image with the thirdprojection image, where one or both the second viewing direction and thethird viewing direction are determined using a periodic continuousmathematical function.

A method for identifying an object in a projection image comprising thesteps of receiving a three dimensional volumetric image of a tissue,computing a plurality of projection images of the three dimensionalvolumetric image of the tissue using a plurality of viewing directions,one or more of time comparing, structurally comparing and dynamicallycomparing the plurality of projection images, and identifying an objectthat is present in a projection image selected from the plurality ofprojection images that is not present in one or more of the one or moreprojection images selected from the plurality of projection images.

A method for identifying an object in a projection image comprising thesteps of receiving a three dimensional volumetric image of a tissue,computing a plurality of projection images of the three dimensionalvolumetric image of the tissue using a plurality of viewing directions,one or more of time comparing, structurally comparing and dynamicallycomparing the plurality of projection images, and identifying an objectthat is present in a projection image selected from the plurality ofprojection images that is not present in one or more of the one or moreprojection images selected from the plurality of projection images,where at least one of the plurality of viewing directions is determinedusing a periodic continuous mathematical function.

A method for identifying an object in a projection image comprising thesteps of receiving a three dimensional volumetric image of a tissue,computing a plurality of projection images of the three dimensionalvolumetric image of the tissue using a plurality of viewing directions,one or more of time comparing, structurally comparing and dynamicallycomparing the plurality of projection images, and identifying an objectthat is present in a projection image selected from the plurality ofprojection images that is not present in one or more of the one or moreprojection images selected from the plurality of projection images,where at least one of the plurality of viewing directions is determinedusing a periodic continuous mathematical function, where the pluralityof projection images is a sequence of projection images spanning oneperiod of the periodic continuous mathematical function.

A method for identifying an object in a projection image comprising thesteps of receiving a three dimensional volumetric image of a tissue,computing a plurality of projection images of the three dimensionalvolumetric image of the tissue using a plurality of viewing directions,one or more of time comparing, structurally comparing and dynamicallycomparing the plurality of projection images, and identifying an objectthat is present in a projection image selected from the plurality ofprojection images that is not present in one or more of the one or moreprojection images selected from the plurality of projection images,where at least one of the plurality of viewing directions is determinedusing a periodic continuous mathematical function, where the pluralityof projection images is a sequence of projection images spanning oneperiod of the periodic continuous mathematical function, furthercomprising rendering and caching a sequence of projection images.

A method for identifying an object in a projection image comprising thesteps of receiving a three dimensional volumetric image of a tissue,computing a plurality of projection images of the three dimensionalvolumetric image of the tissue using a plurality of viewing directions,one or more of time comparing, structurally comparing and dynamicallycomparing the plurality of projection images, and identifying an objectthat is present in a projection image selected from the plurality ofprojection images that is not present in one or more of the one or moreprojection images selected from the plurality of projection images,where at least one of the plurality of viewing directions is determinedusing a periodic continuous mathematical function, where the pluralityof projection images is a sequence of projection images spanning oneperiod of the periodic continuous mathematical function, furthercomprising rendering and caching a sequence of projection images, wherethe rendered and cached sequence of projection images are played backone or more times.

A method for identifying an object in a projection image comprising thesteps of receiving a three dimensional volumetric image of a tissue,computing a plurality of projection images of the three dimensionalvolumetric image of the tissue using a plurality of viewing directions,one or more of time comparing, structurally comparing and dynamicallycomparing the plurality of projection images, and identifying an objectthat is present in a projection image selected from the plurality ofprojection images that is not present in one or more of the one or moreprojection images selected from the plurality of projection images,where at least one of the plurality of viewing directions is determinedusing a periodic continuous mathematical function, where the pluralityof projection images is a sequence of projection images spanning oneperiod of the periodic continuous mathematical function, furthercomprising rendering and caching a sequence of projection images, wherethe rendering is carried out on a server.

A method for identifying an object in a projection image comprising thesteps of receiving a three dimensional volumetric image of a tissue,computing a plurality of projection images of the three dimensionalvolumetric image of the tissue using a plurality of viewing directions,one or more of time comparing, structurally comparing and dynamicallycomparing the plurality of projection images, and identifying an objectthat is present in a projection image selected from the plurality ofprojection images that is not present in one or more of the one or moreprojection images selected from the plurality of projection images,where at least one of the plurality of viewing directions is determinedusing a periodic continuous mathematical function, where the pluralityof projection images is a sequence of projection images spanning oneperiod of the periodic continuous mathematical function, furthercomprising rendering and caching a sequence of projection images, wherethe caching is carried out on a client computer.

A method for identifying an object in a projection image comprising thesteps of receiving a three dimensional volumetric image of a tissue,computing a plurality of projection images of the three dimensionalvolumetric image of the tissue using a plurality of viewing directions,one or more of time comparing, structurally comparing and dynamicallycomparing the plurality of projection images, and identifying an objectthat is present in a projection image selected from the plurality ofprojection images that is not present in one or more of the one or moreprojection images selected from the plurality of projection images,where at least one of the plurality of viewing directions is determinedusing a periodic continuous mathematical function, where the pluralityof projection images is a sequence of projection images spanning oneperiod of the periodic continuous mathematical function, furthercomprising rendering and caching a sequence of projection images, wherethe rendering is carried out on a server, where the play back is carriedout on a client computer.

A method for identifying an object in a projection image comprising thesteps of receiving a three dimensional volumetric image of a tissue,computing a plurality of projection images of the three dimensionalvolumetric image of the tissue using a plurality of viewing directions,one or more of time comparing, structurally comparing and dynamicallycomparing the plurality of projection images, and identifying an objectthat is present in a projection image selected from the plurality ofprojection images that is not present in one or more of the one or moreprojection images selected from the plurality of projection images,where at least one of the plurality of viewing directions is determinedusing a periodic continuous mathematical function, where a graphicsprocessing unit is used to compute one or more of the plurality ofprojection images.

A method for identifying an object in a projection image comprising thesteps of receiving a three dimensional volumetric image of a tissue,computing a plurality of projection images of the three dimensionalvolumetric image of the tissue using a plurality of viewing directions,one or more of time comparing, structurally comparing and dynamicallycomparing the plurality of projection images, and identifying an objectthat is present in a projection image selected from the plurality ofprojection images that is not present in one or more of the one or moreprojection images selected from the plurality of projection images,where at least one of the plurality of viewing directions is determinedusing a periodic continuous mathematical function, where a graphicsprocessing unit is used to compute one or more of the plurality ofprojection images, where bricking is used to accelerate computation ofone or more of the plurality of projection images.

A method for identifying an optimal projection image comprising thesteps of receiving a volumetric image, computing the plurality ofprojection images based on the volumetric image using a plurality ofviewing directions, and comparing the plurality of projection images todetermine an optimal viewing direction corresponding to an optimalprojection image.

A method for identifying an optimal projection image comprising thesteps of receiving a volumetric image, computing the plurality ofprojection images based on the volumetric image using a plurality ofviewing directions, and comparing the plurality of projection images todetermine an optimal viewing direction corresponding to an optimalprojection image, where the optimal viewing direction is selected fromthe group consisting of a viewing direction that identifies anunobserved obstruction, a viewing direction that improves the visualclarity of the first projection image, a viewing direction that improvesthe visual clarity of the second projection image, a viewing directionthat improves the visual clarity of identification of an obstruction, aviewing direction that identifies an obstruction using directcomparison, a viewing direction that improves the direct comparisonclarity of the first projection image, a viewing direction that improvesthe direct comparison clarity of the second projection image, and aviewing direction that improves the direct comparison clarity ofidentification of an obstruction.

A method for displaying a plurality of projection images comprising thesteps of receiving a volumetric image, computing the plurality ofprojection images based on the volumetric image using a plurality ofviewing directions and displaying the plurality of projection images.

A method for comparing a first projection image and a second projectionimage comprising the steps of receiving a volumetric image, computingthe first projection image based on the volumetric image using a firstviewing direction, computing the second projection image based on thevolumetric image using a second viewing direction, where the firstviewing direction is not equal to the second viewing direction and oneor more of time comparing, structurally comparing and dynamicallycomparing the first projection image and the second projection image.

A method for comparing a first projection image and a second projectionimage comprising the steps of receiving a volumetric image, computingthe first projection image based on the volumetric image using a firstviewing direction, computing the second projection image based on thevolumetric image using a second viewing direction, where the firstviewing direction is not equal to the second viewing direction and oneor more of time comparing, structurally comparing and dynamicallycomparing the first projection image and the second projection image,further comprising one or more steps selected from the group consistingof identifying visually an obstruction, improving the visual clarity ofthe first projection image, improving the visual clarity of the secondprojection image, improving the visual clarity of identification of anobstruction, identifying an obstruction using direct comparison,improving the direct comparison clarity of the first projection image,improving the direct comparison clarity of the second projection image,and improving the direct comparison clarity of identification of anobstruction.

A method for displaying one or more unobstructed projection imagescomprising the steps of receiving a volumetric image, computing aplurality of projection images based on the volumetric image using aplurality of viewing directions, where at least a first projection imageof the plurality of projection images is computed using a first viewingdirection and at least a second projection image of the plurality ofprojection images is computed using a second viewing direction, wherethe first viewing direction is not equal to the second viewingdirection, one or more of time comparing, structurally comparing anddynamically comparing the first projection image and the secondprojection image to determine if one or both of the first projectionimage and the second projection image are unobstructed, and displayingbased on the comparison one or both the first projection image and thesecond projection image.

A method for displaying an unobstructed projection image of a breastcomprising the steps of receiving a volumetric image of the breast,computing a first projection image of the breast based on the volumetricimage using a first viewing direction and a second projection image ofthe breast based on the volumetric image using a second viewingdirection, where the first viewing direction is not equal to the secondviewing direction, one or more of time comparing, structurally comparingand dynamically comparing the second projection image of the breast withthe first projection image of the breast to determine if one or both thefirst projection image of the breast and second projection image of thebreast is unobstructed, and based on the comparison displaying one orboth the first projection image of the breast and second projectionimage of the breast.

A system for displaying unobstructed breast projection images comprisingreceiving a plurality of volumetric images of a breast, where a firstvolumetric image of the plurality of projection images is measured at afirst time and a second volumetric image of the plurality of projectionimages is measured at a second time, where the first time differs fromthe second time by a time interval, computing a first projection imagefrom the first volumetric image measured at the first time using a firstviewing direction, computing one or more projection images from thefirst volumetric image measured at the first time using one or moreviewing directions, one or more of time comparing, structurallycomparing and dynamically comparing the first projection image and theone or more projection images to determine an unobstructed viewingdirection, where a second projection image corresponds with the one ormore projection images at the unobstructed viewing direction, computinga third projection image from the second volumetric image measured atthe second time using the unobstructed viewing direction, and displayingthe second projection image and the third projection image.

A system for displaying unobstructed breast projection images comprisingreceiving a plurality of volumetric images of a breast, where a firstvolumetric image of the plurality of projection images is measured at afirst time and a second volumetric image of the plurality of projectionimages is measured at a second time, where the first time differs fromthe second time by a time interval, computing a first projection imagefrom the first volumetric image measured at the first time using a firstviewing direction, computing one or more projection images from thefirst volumetric image measured at the first time using one or moreviewing directions, one or more of time comparing, structurallycomparing and dynamically comparing the first projection image and theone or more projection images to determine an unobstructed viewingdirection, where a second projection image corresponds with the one ormore projection images at the unobstructed viewing direction, computinga third projection image from the second volumetric image measured atthe second time using the unobstructed viewing direction, and displayingthe second projection image and the third projection image, furthercomprising computing a fourth projection image from the secondvolumetric image measured at the second time using the first viewingdirection.

A method for identifying additional lesions in a tissue comprising thesteps of computing a plurality of projection images of the tissue usinga plurality of viewing directions, where a first projection image iscomputed using a first viewing direction and a second projection imageis computed using a second viewing direction, displaying the firstprojection image and the second projection image, one or more of timecomparing, structurally comparing and dynamically comparing the firstprojection image and the second projection image, visually identifyingan intense spot that separates in the second projection image from thefirst projection image.

A system that displays a first projection image and a second projectionimage of a volumetric image comprising a processor responsive to acommand to select a volumetric image one or more digital data processorscapable of carrying out the steps including, computing a firstprojection image of the volumetric image using a first viewingdirection, computing a second projection image of the volumetric imageusing a second viewing direction, and graphics resources for displayingthe first projection image and the second projection image.

A system that compares a first projection image and a second projectionimage of a volumetric image comprising a processor responsive to acommand to select a volumetric image, one or more digital dataprocessors capable of carrying out the steps including computing a firstprojection image of the volumetric image using a first viewingdirection, computing a second projection image of the volumetric imageusing a second viewing direction, and graphics resources for comparingthe first projection image and the second projection image.

A method for displaying one or more unobstructed projection imagescomprising the steps of receiving a volumetric image, computing aplurality of projection images based on the volumetric image using aplurality of viewing directions, where at least a first projection imageof the plurality of projection images is computed using a first viewingdirection and at least a second projection image of the plurality ofprojection images is computed using a second viewing direction, wherethe first viewing direction is not equal to the second viewingdirection, one or more of time comparing, structurally comparing anddynamically comparing the first projection image and the secondprojection image to determine if one or both of the first projectionimage and the second projection image are unobstructed, and displayingbased on the comparison one or both the first projection image and thesecond projection image.

A method of visualizing a dynamic comparison of a volumetric imagecomprising the steps of receiving the volumetric image, computing aplurality of projection images of the volumetric image using a pluralityof viewing directions between a smallest viewing direction and a largestviewing direction, and displaying a video showing the plurality ofprojection images, where the viewing direction changes with time.

Often, the traditional ‘Hanging Protocol’ is either not intuitive,cannot display the information in a manner in which it can be reviewedor is not the most efficient way to display images. Alternative ways ofrendering the acquired images can be more efficient or more appropriatefor displaying the information. Examples include Volume Renderingtechniques or maximum intensity projections of stacks of cross-sectionalimages, rendering of oblique slices, rendering of thick slices or slabs,or rendering of fused images (e.g. in PET/CT). Specialized diagnosticworkstations that are often specific to a clinical application area areused to provide appropriate rendering of the acquired images. Asorganizations and doctors require better and faster visualizationmethods that allow users to interact with the image data in real-time,the requirements and demands for displaying the data will increase.

FIG. 11 depicts an example study where the rules have created two Setsof Images. One Set of Images consists of a series of CT images forming a3D volume, which is depicted in a volume rendered style in the Viewport1160 in the upper left and in three orthogonal cross sections in thethree other viewports in the left half of the screen. The second Set ofImages consist of one chest X-Ray, assigned to a single Viewport 1160covering the right half of the screen and rendering the X-Ray in 2Dstyle. Appropriate data windows have been chosen by the rules tohighlight the vasculature in the 3D rendering, as this is a study withcontrast, as the rules can determine by the StudyDescription containingthe word ‘contrast’.

FIG. 10 is a flow chart showing how the rules are used to create the twoSets of Images shown in FIG. 11. As shown in FIG. 10, a primary Study1105 which can be manually selected by a user. In step (i) 1120, basedon Study Selection Rules 1115 which interrogate parameters in theprimary Study 1105 such as DICOM Parameters and Abstract Tags of boththe primary Study 1105 and the candidate studies 1110, the StudySelection Rules 1115 can identify additional candidate studies 1110. Thesecond set of studies 1125 which includes the candidate studies 1110 andthe primary Study 1105 are available to be loaded into Viewports 1160.In step (ii) 1140, the Protocol Selection Rules 1135 select a DisplayProtocol 1145 from the Available Display Protocols 1130 based on DICOMParameters and Abstract Tags present in the second studies 1125. In step(iii) 1155, Image Set Rules 1150 are used to define a plurality of ImageSets 1165 from the second studies 1125. The one or more Viewports 1160are defined in the Display Protocol 1145. In step (iv) 1175, ViewportAssignment Rules 1170 assign one or more Image Sets 1165 to one or moreViewports 1160. In step (v) 1185, Style Rules 1180 define a renderingstyle and rendering parameters. In an embodiment of the invention steps(i) through (v) are performed by a server processor running a renderserver program with an interface shown in FIG. 12A in which the rules(Study Selection Rules 1115, Protocol Selection Rules 1135, Image SetRules 1150, Viewport Assignment Rules 1170, and the one or more StyleRules 1180) are used to automatically select and display the Image Sets1165 in the Viewports 1160 for a prior chest CR analysis. In anembodiment of the invention steps (i) through (v) are performed by aserver processor running a render server program with an interface shownin FIG. 12B in which the rules (Study Selection Rules 1115, ProtocolSelection Rules 1135, Image Set Rules 1150, Viewport Assignment Rules1170, and the one or more Style Rules 1180) are used to automaticallyselect and display the Image Sets 1165 in the Viewports 1160 for a priorleft breast mammogram analysis.

A render server program is described in U.S. application Ser. No.13/831,967, entitled ‘Multi-User Mult-GPU Render Server Apparatus andMethods’, inventors M. Westerhoff et al., which was filed Mar. 15, 2013is herein expressly incorporated by reference in its entirety. A rulebased render server program is described in ‘Method and System for RuleBased Display of Sets of Images’, inventors M. Westerhoff et al., whichissued as U.S. Pat. No. 8,976,190 on Mar. 10, 2015, and is hereinincorporated by reference in its entirety. A program for improving datatransfer is described in U.S. patent application Ser. No. 13/831,982filed on Mar. 13, 2013, entitled ‘Method and System for TransferringData to Improve Responsiveness when Sending Large Data Sets’, inventorsD Stalling et al., which is herein incorporated by reference in itsentirety.

Study Selection Rules 1115

In an embodiment of the present invention, based on the Study that theuser selects for display (primary Study 1105), the system can firstapply user defined rules to determine additional studies to be displayedtogether with the primary Study 1105. Such additional studies can beprior examinations that are relevant for the diagnosis of the currentStudy, or additional current studies. For example, a PET examinationwill often be looked at together with a CT examination acquired at thesame time. The set of rules are constructed as follows:

Each rule consists of a matching criterion for the primary Study 1105(primary condition), as well as matching criteria for additional studies(secondary condition). The matching criterion is an expressionconsisting of operators that allow evaluating the parameters of theStudy and comparing them to defined values. The parameters of the Studyare any parameters defined by the DICOM standard, such as StudyDescription, Study Date, Modality, Patient Age, as well as any otherparameters that can be derived from the DICOM parameters or from theStudy itself, such as number of images, or number of image series. Theoperators are numeric or string based operators, such as equals, greaterthan, less than, contains, etc. Expressions can be combined usingBoolean operators such as AND, OR, NOT. Operators can also contain morecomplex expressions, including user defined functions defined in anappropriate programming language, such as JavaScript or VisualBasic.

Once a primary Study 1105 has been selected for display, the primarycondition of each rule is evaluated. Those rules that match, i.e.,evaluate to ‘true’ for the given primary Study 1105, will then beapplied to all other studies that are available for the same patient.Those other studies for which the secondary condition matches will beadded to the list of studies to be displayed.

The following rule illustrates the concept. This rule will automaticallyload prior Chest X-Rays or prior Chest CT if the primary Study 1105 is aChest X-RAY.

Study Selection Rule 1:

IF (Primary.Dicom.BodyPartExamined=‘CHEST’ andPrimary.Dicom.Modality=‘CR’) THEN SELECT other studies for loading WHERE(Other.Dicom. BodyPartExamined=‘CHEST’ and (Other.Dicom.Modality=‘CR’ orOther.Dicom.Modality=‘CT’))

The rule is expressed in pseudo-code with the primary conditionspecified in the IF-clause and the secondary condition expressed in theSELECT-clause.

Study Selection Rules: Normalization of DICOM Parameters

In an embodiment of the present invention, the rules can normalize DICOMparameters. As described above, a Study Selection Rule can containarbitrary DICOM parameters. The DICOM standard specifies if a particularparameter is defined on a patient, Study, series, or image level. Forexample, a Study-level parameter should have the same value in allimages of a Study, while a series-level parameter should have the samevalue in all images of a series. There are two problems related toassuming that this statement is always the case. Firstly, although aStudy-level tag should have the same value for all images of a Studythis is not always true. Secondly, some parameters are defined on aseries- or image-level (e.g. modality is a series-level parameter) andtherefore can be unavailable. In both cases it can be unclear what valueis to be used when evaluating the rule. The invention described hereprovides different solutions to this problem.

In an embodiment of the present invention, a first approach is to choosea reference image and to read the value of a particular DICOM parameterfrom the reference image. The reference image can be: (i) the image thatwas inserted into the system first, (ii) the image with the oldest imagecontent date, (iii) the image that was inserted into the system last, or(iv) the image with the earliest image content date. The choice of whichimage is to be chosen as the reference image can be configured for eachparameter separately.

In an embodiment of the present invention, a second approach is to onlyallow original images to be chosen as the reference image. Non-viewableDICOM objects like structured reports, key objects, or presentationstates are disregarded, as well as derived images such as secondarycapture images or reformatted images.

In an embodiment of the present invention, a third approach is toprovide a list of all distinct values that a particular DICOM parameterhas in the images of a Study. In a Study Selection Rule one can thencheck if that list contains a particular value. The example above canthen read as follows:

Study Selection Rule 2:

IF (Primary.Dicom.BodyPartExamined=‘CHEST’ andPrimary.DicomList.Modality contains ‘CR’) THEN SELECT other studies forloading WHERE (Other.Dicom.BodyPartExamined=‘CHEST’ and(Other.DicomList.Modality contains ‘CR’ or Other.DicomList.Modalitycontains ‘CT’))

Study Selection Rules: Abstract Tags

In an embodiment of the present invention, the Study Selection Rules1115 contain other derived parameters such as Abstract Tags thatcharacterize a Study in addition to or instead of DICOM parameters.Abstract tags that are useful within Study Selection Rules 1115 includethe following:

(i) RelativeStudyAge indicates relative age of Study in days compared toprimary Study 1105.(ii) PriorIndex indicates an index that enumerates all other studiesfrom youngest to oldest.(iii) NumImages indicates number of images in Study.(iv) NumSeries indicated number of image series in Study.(v) Num3DVolumes indicates number of 3D volumes in Study.(vi) Num4DSequences indicates number of 4D sequences in Study (e.g.Cardiac CT).(vii) HasReport indicates a flag that indicates if a report is availablefor a Study.(viii) HasThinSliceVolumes indicates whether the study has at least oneset of images that form a true 3D volume, i.e. a sufficiently largenumber of equidistant slices (the exact number can be user configurable,e.g. 30 would be a common choice) and a sufficiently small spacingbetween two consecutive slices to guarantee an isotropic (or close toisotropic) (again, this parameter can be user defined, values between 1mm and 3 mm are common thresholds for CT and MR examinations).

For example, a rule that applies to a Mammogram Study and that selectsat maximum three prior Mammogram studies no older than five years canread as follows:

Study Selection Rule 3:

IF (Primary.Dicom.Modality=‘MG’ THEN SELECT other studies for loadingWHERE (Other.Dicom.Modality=‘MG’ and Other.Abstract.Priorindex<=3 andOther.Abstract.RelativeStudyAge<5*365)

Protocol Selection Rules 1135

In an embodiment of the present invention, once the studies to bedisplayed are determined as described above, a suitable display protocolcan be selected. This is done using matching rules. Each matching ruleconsists of conditions that are applied to the primary and other studiesto be loaded. Like in Study Selection Rules 1115, protocol selectionrules may contain DICOM parameters (either taken from a reference imageor provided as a list of distinct values gathered from all images of astudy), as well as abstract tags and user-defined functions. Eachmatching rule has a score and an associated display protocol.

In an embodiment of the present invention, all matching rules areevaluated and the display protocol of the matching rule that evaluatesto true can be selected. If multiple matching rules evaluate to true,the one with the highest score can be selected.

The following example rule illustrates a matching rule that can applyfor PET/CT studies of the abdomen to select a protocol named‘StandardPetCTProtocol1’ with a score of 10.

Protocol Selection Rule 1:

IF (Primary.Dicom.BodyPartExamined=‘ABDOMEN’ andPrimary.Dicom.Modality=‘CT’ and Exists(Other1) andOther1.Dicom.Modality=‘PET’) THEN SELECT ‘StandardPetCTProtocol1’ withscore=10

In an embodiment of the present invention, the rule is expressed inpseudo-code with the matching condition specified in the IF-clause andthe chosen protocol specified by the SELECT.

Image Set Rules 1150

In an embodiment of the present invention, once a display protocol isselected, further rules defined within the protocol are evaluated. Thenext step comprises creation of so-called image sets. An image setconsists of images that are logically grouped together. Usually, animage set is represented by a single preview icon in the application. Itis an image set that is loaded into a viewer or tiled viewer. Note thatDICOM series also represent a logical grouping of images. However, oftenDICOM series are not well suited for hanging of images and viewing. Forexample, in Mammography a single DICOM series may contain images of bothleft and right breast, in MRI it may contain both T1 and T2 images, orin CT it may contain both a localizer image (topogram) and a 3D imagestack. In all these cases the DICOM series can be split into differentlogical image sets. On the other hand, multiple DICOM series mayrepresent the phases of a single 4D cardiac data set. In this case allthose series can be joined into a single logical image set.

Thus the creation of image sets based on rules is a key component of therule-based display system, specifically for the more advanced renderingtechniques. For example, the rules-based display system is used tocreate image sets that are very similar to the rules described above inStudy Selection Rules 1115 and Protocol Selection Rules 1135 sections. Arule is a Boolean expression that can contain DICOM parameters, abstracttags, or used-defined functions that are based on the DICOM parameters,abstract tags, or used-defined functions. Image set rules however, areapplied to all images of a study that was selected for loading (and notto the study itself). Image-level parameters thus represent no problemand do not need to be normalized or otherwise treated specially. Allimages that match an image-set rule are grouped into a respective imageset.

In an embodiment of the present invention, the following rule (expressedin pseudo-code) collects all images of a current CT study:

Image Set Rule 1: IF (Dicom.Modality=‘CT’ and Abstract.Priorindex=0)

THEN CREATE image set with ID 1

In an embodiment of the present invention, the resulting image sets canbe assigned IDs or names that allow for referencing the image sets laterin layout and display set rules. In the above example an image set withID 1 was defined. If no image matches an image set rule, no suchcorresponding image set will be created.

Image Set Rules: Sorting

In an embodiment of the present invention, the order of images within animage set is an important aspect. It determines how images are shownwhen the user browses through the image set or how images aredistributed into the tiles of a tiled viewer. In one embodiment of thepresent invention, in order to specify image sorting, the image setrules can contain an ordered list of sorting criteria. All images thatare matched by a rule are sorted according to those criteria.

For example, the following rule collects all images of a current CTstudy and sorts them according to DICOM series number at first and DICOMinstance/image number at second.

Image Set Rule 2: IF (Dicom.Modality=‘CT’ and Abstract.Priorindex=0)

THEN CREATE image set with ID 1

SORTED BY Dicom.SeriesNumber ORDER:=ascending

SORTED BY Dicom.InstanceNumber ORDER:=ascending

Image Set Rules: Splitting

In an embodiment of the present invention, sorting criteria can beextended by a split flag. With the split flag it is possible to createmultiple image sets from a single image set rule. When the value of asorting criterion with split flag set to true changes, sub-sequentimages are automatically inserted into a new image set. The resultingimage sets are automatically enumerated by a sub-level ID.

For example, the following rule essentially creates image sets thatcorrespond to DICOM series, because all images with different seriesnumber will be split into different sets:

Image Set Rule 3: IF (Dicom.Modality=‘CT’ and Abstract.Priorindex=0)

THEN CREATE image set with ID 1.x

SORTED BY Dicom.SeriesNumber ORDER:=ascending SPLIT:=true

SORTED BY Dicom.InstanceNumber ORDER:=ascending SPLIT:=false

In applications where a CT has been measured, it can happen that a studycontains both a soft-kernel series and a hard kernel series and bothseries have the same series number. In order to separate the images intodifferent image sets the above rule can be extended by the following:

Image Set Rule 4: IF (Dicom.Modality=‘CT’ and Abstract.Priorindex=0)

THEN CREATE image set with ID 1.x

SORTED BY Condition.CTSoftTisseKernel SPLIT:=true

SORTED BY Dicom.SeriesNumber ORDER:=ascending SPLIT:=true

SORTED BY Dicom.InstanceNumber ORDER:=ascending SPLIT:=false

Here, Condition.CTSoftTissueKernel denotes a user-defined Booleancondition that tests whether an image has a CT soft-tissue kernel. Theactual implementation of this condition can for example evaluate themanufacturer (which is encoded in a DICOM parameter). Depending on itsvalue the rule can evaluate further parameters to find out if an imagewas reconstructed using a soft-tissue kernel or not. Since this Booleancondition was used as a sorting criterion with the split flag set totrue, all non-soft-kernel images can be put into an image set with ID1.1 and all soft-kernel images can be put into an image set with ID 1.2(unless the image set is further split and IDs like 1.3 or 1.4 arecreated).

Image Set Rules: More Abstract Tags

In an embodiment of the present invention, additional abstract tags areused in image set rules. One example is a tag that identifies whether animage has already been put into an image set. In principle, a singleimage can be put into multiple image sets, but sometimes this should beavoided. This can be achieved by evaluating image set rules in apre-defined order and introducing an abstract tag AlreadyReferenced.

For example, in CT study that has a localizer image and a 3D image stackboth stored in one DICOM series, one may want to create an image set,one for the localizer and one for the 3D image stack. Accordingly, theimage set rules are defined as follows:

Image Set Rule 5 (Localizer):

IF (Dicom.Modality=‘CT’ and Condition.IsLocalizer=true)THEN CREATE image set with ID 1

SORTED BY Dicom.SeriesNumber ORDER:=ascending SPLIT:=true

SORTED BY Dicom.InstanceNumber ORDER:=ascending SPLIT:=false

Image Set Rule 6 (Images):

IF (Dicom.Modality=‘CT’ and Abstract.AlreadyReferenced=false)THEN CREATE image set with ID 2

SORTED BY Dicom.SeriesNumber ORDER:=ascending SPLIT:=true

SORTED BY Dicom.InstanceNumber ORDER:=ascending SPLIT:=false

Here Condition.IsLocalizer is a user-defined condition that returns trueif an image is a localizer image, and false otherwise. In an embodimentof the present invention, Rule 1 is applied first. Therefore thelocalizer image is put into a separate image set with ID 1. Next rule 2is applied. This rule can match for all CT images including thelocalizer image. However, because AlreadyReferenced=false is specified,the localizer image is skipped and not placed into image set 2.

In an embodiment of the present invention, the creation of the imagesets based on rules is a key component of the efficient rules baseddisplay, specifically for the more advanced rendering techniques. Forexample rules can be used to identify sets of 2D images that togetherform a 3D volume.

Viewer Assignment Rules

In another embodiment of the present invention, a display protocoldefines multiple viewers, each with one or more tiles, i.e., viewports.To each viewer one or more image sets can be assigned based on ViewerAssignment Rules that are similar to the protocol section rulesdescribed herein. Viewer Assignment Rules are defined in the displayprotocol. The rules determine which image set shall be initially shownin a viewer. In case multiple image sets are assigned to a viewer, theone with the highest score is chosen. Afterwards users may cycle quicklythrough the remaining image sets using dedicated tools (Previous/NextImage Set), or pick another image set from a special image set menu.

Like the other rule types Viewer Assignment Rules contain Booleanexpressions of DICOM parameters, abstract tags, or user-definedconditions based on DICOM parameters, or abstract tags. In many cases itis sufficient to specify the image sets to be assigned to a viewer bytheir image set ID instead of evaluating the underlying DICOM parametersand abstract tags again. Therefore, the image set ID is simply set as aseparate abstract tag. In the following example the two rules load imagesets with the IDs 1 and 2 into a viewer, but assign ID 1 a higher scoreso that this image set is initially visible (provided such an image setexists):

Viewer Assignment Rule 1: IF (EXISTS ImageSet[1])

THEN Viewport[0].AddImageSet(ID=1, score=10)

Viewer Assignment Rule 2: IF (EXISTS ImageSet[2]) THEN

Viewport[0].AddImageSet(ID=2, score=5)

In an embodiment of the present invention, viewer assignment rules areapplied to image sets. Thus there is a possible conflict regardingambiguous image-level and series-level tags. This conflict is resolvedin the same way as described herein in the Normalization of DICOMParameters section. This means that values of DICOM parameters, but alsoabstract tags, are automatically taken from some reference image.Alternatively, for all DICOM parameters a list of distinct valuesoccurring in all images of the image set can be used in an assignmentrule.

Style Rules

In one embodiment of the present invention, there is a final set ofrules that specify the rendering style and other rendering parameters tobe used when showing a particular image set. For example, for a CTAngiogram study, often a volume rendering style display (VRT) isdesired, whereas for a study looking for lung nodules a maximumintensity projection (MIP) of 20 mm slabs may be desired. Style rules,that can be user specific, allow driving that automatically. The rulescan use the same parameters as discussed above, as well as the existenceor absence of certain image sets.

In one embodiment of the present invention, the system uses a global,ordered list of style rules that is evaluated independently for eachviewer and each image set loaded into a viewer. An abstract tagDisplaySetID is provided that allows formulating style rules for aspecific viewer or group of viewers.

Parameters driven by Style Rules include the following:

i) Rendering style (can be 2D, oblique, curved, MIP slab, 3D MIP, VRT,shaded VRT, etc.);ii) Image alignment (left, right, top, bottom, centered);iii) Inverse display (black on white versus white on black);iv) Colormap or transfer function;v) Window/level (data window);vi) Slice thickness;vii) Zoom factor;viii) Camera position and orientation; andix) Labels/OverlayDisplay of labels, annotations and other overlayelements.

The following is an example of a style rule that activates inverse 3DMIP rendering in all viewers with a DisplaySetID between 101 and 104,provided a PET data set is loaded into those viewers (modality PT, i.e.,positron emission tomography). Also, an automatic window/level settingis used that is computed from the histogram of the image set (the 2%lowest values are all mapped to white, and the 2% highest values are allmapped to black):

Style Rule 1: IF (Abstract.DisplaySetID>100 and

Abstract.DisplaySetID<105 and

Dicom.Modality=TT′)

THEN SET

RenderingStyle:=‘3D MIP’

Inverse:=true

DataWindow:=‘2% 98%’

The following is another example of a different style rule that alwayscauses the image set with image set ID 200 to be displayed in MPR modeusing 20 mm thick slices, with a window/level as specified in the DICOMparameters, and with a zoom factor so that the whole viewer window isfilled out. The rule is:

Style Rule 2: IF (Abstract.ImageSetID=200) THEN SET

RenderingStyle:=‘MPR’

SliceThickness:=‘20’

DataWindow:=‘DICOM1’

ZoomFactor:=‘FitToWindow’

Summary of Rule Types

Table I summarizes all types of rules that are applied in the rule-basedisplay system:

TABLE I Normalized Rule Type Applies to Parameters Defined where StudySelection Rule Studies yes globally Protocol Selection Rule Studies yesglobally Image Set Rule Images not required protocol Viewer AssignmentRule Image Sets yes globally, protocol Style Rule Image Sets yesglobally, protocol

Example Shown in FIG. 11

An example of how these aspects can be combined is shown in FIG. 11. Inthe example the user has selected a CT examination of the abdomen. Thefollowing rules have been used to determine that a recent X-Ray of thechest is relevant and shall be displayed as well: IF(Primary.Dicom.BodyPartExamined=‘ABDOMEN’ andPrimary.Dicom.Modality=‘CT’) THEN SELECT other studies for loading WHERE(Other.Dicom. BodyPartExamined=‘ABDOMEN’ OR Other.Dicom.BodyPartExamined=‘CHEST’) and (Other.Dicom.Modality=‘CR’ orOther.Dicom.Modality=‘CT’) AND Other.RelativeStudyAge<‘90 days’

From this rule, a hanging protocol can be selected. In the example theprotocol selection rules determine that the CT study is a thin slice CTstudy (i.e. that it has image series that form a 3D volume withsufficient resolution in all directions to display volume rendering ornon-axial slices in a meaningful way). Furthermore the example ruledetermines that this is a study with enhanced vasculature, by lookingfor the key words ‘contrast’ or ‘angio’ in the study description. Thedisplay protocol selection rule that applies here and select theprotocol CTThinSliceVesselWithPrior can read

IF (Primary.Dicom.BodyPartExamined=‘ABDOMEN’ andPrimary.Dicom.Modality=‘CT’ and Primary.Abstract.HasThinSliceVolumes and(Primary.Dicom.StudyDescription containsAnyOf ‘contrast, angio’ andexists Other1 THEN SELECT ‘CTThinSliceVesselWithPrior’ with score=10

From this image sets are generated using Image Set Rules:

IF (Dicom.Modality=‘CT’ and Abstract.Priorindex=0 andCondition.IsPartOfThinSliceVolume and Condition.CTSoftTisseKernel)

THEN CREATE image set with ID 1.x

SORTED BY Abstract.NumberOfSlicesInVolume ORDER:=descending SPLIT:=true

SORTED BY Dicom.SeriesNumber ORDER:=ascending SPLIT:=true

SORTED BY Dicom.Abstract.VolumeIndex ORDER:=ascending SPLIT:=true

SORTED BY Dicom.Abstract.SlicePosition ORDER:=ascending SPLIT:=false

This rule will actually form sets from images that contain images thatare part of a ThinSliceVolume and that have been reconstructed with a‘soft tissue’ kernel. Given the protocol selection rule has specificallymatched for just CT studies, the conditions Dicom.Modality=‘CT’ andAbstract.Priorindex=0 are actually redundant, but could be useful if adifferent selection rule was used.

The images will first be sorted by the size of the volume of which theyare part (Abstract.NumberOfSlicesInVolume), then by DICOM series. Thesplit parameter in this case will ensure that an image set containsimages from on series only. A DICOM series can sometimes containmultiple non-consecutive volumes. The abstract tag VolumeIndex will thenindicate for each image, which of those volumes it is part of. If aseries contains only one volume, then this will be ‘1’ for all images inthe series. The split=true in this part of the rule would result in aseparate image set for each of those volumes. Finally, within eachvolume, the images are ordered by slice position, but not split. Thisway we end up with one image set for each soft kernel thin slice volume,the largest volume being the first image set (ID 1.1). This ID will beused further in subsequent rules.

The rule to form an image set from any CR prior study in this example ismuch simpler:

IF (Dicom.Modality=‘CR’ and Abstract.Priorindex=1)

THEN CREATE image set with ID 10

SORTED BY Dicom.SeriesNumber ORDER:=ascending SPLIT:=false

SORTED BY Dicom.InstanceNumber ORDER:=ascending SPLIT:=false

This creates one image set with ID=10 containing all images for thefirst prior study, if that is a CR.

In practice, additional rules, such as Image Set Rule 5 and 6 (seeabove) will be used to collect the remaining images of the primary Study1105. The remaining images are not shown in the layout depicted in theexample FIG. 11.

The Display Protocol 1145 contains multiple layouts. The one shown inFIG. 11 is defined as follows:

DEFINE Layout { ID=‘Layout5’; NAME=‘+PlainFilm’ Viewports {  { ID=50,Geometry=‘(0,0)-(0.25,0.5)’},  { ID=51, Geometry=‘(0.25,0)-(0.5,0.5)’}, { ID=52, Geometry=‘(0,0.5)-(0.25,1)’},  { ID=53,Geometry=‘(0.25,0.5)-(0. 5,0.5)’},  { ID=54, Geometry=‘(0.5,0)-(1,1)’,Style=‘2D’}  } }

In this example the geometry is defined in a coordinate system havingthe origin in the upper left corner of the screen with the x axispointing to the right and the y axis pointing down. Please note howparameters of the viewers can be set in the layout definition.Parameters can also be set or overridden in the assignment and stylerules, as will be explained next.

In this example, viewer assignment and style rules are as follows:

IF ImageSetExists (1.1) and ImageSetExists(10) THEN SHOW_LAYOUT Layout5WITH  Viewport[0].AddImageSet(1.1)  Viewport [0].Style=‘VRT(diffuse)’ Viewport [0].Colormap=‘CTAngioSoftTissue’  Viewport[1,2,3].AddImageSet(1.1)  Viewport [1,2,3].Style=‘MPR’  Viewport[1,2,3].DataWindow=‘DICOM1’  Viewport [1].orientation=‘axial’  Viewport[2].orientation=‘sagittal’  Viewport [3].orientation=‘coronal’  Viewport[4].AddImageSet(10)  IF (ImageSet[10].Dicom.Columns > 1024) THEN Viewport[4].Zoom=‘FitToWindow’  ELSE  Viewport[4].Zoom=‘1:1’

In this particular example, the rule to select the layout is rathersimple: It is shown if the two image sets used exist. This is becausethe criteria to construct these images sets have been rather specific.As will be appreciated, the proposed system gives this type offlexibility.

Aspects of the Invention

Some aspects of this invention include methods of displaying one or moreSets of Images comprising the steps of: a. selecting a primary Study; b.selecting one or more Study Selection Parameters based on the primaryStudy; c. selecting one or more Study Selection Rules based on the oneor more Study Selection Parameters; d. selecting one or more Sets ofImages from a plurality of images based on the one or more StudySelection Rules; e. selecting one or more Display Protocol SelectionParameters based on the one or more Sets of Images selected; f.selecting one or more Display Protocol Selection Rules based on the oneor more Display Protocol Selection Parameters; g. selecting one or moreDisplay Parameters using the one or more Display Protocol SelectionRules; and h. displaying the one or more Sets of Images according to theDisplay Parameters.

Additional aspects include methods one or more Display Parameter areselected from the group consisting of Image Set Selection Parameters andView and Viewport Selection Parameters.

Further aspects include methods where the one or more Display Parametersare selected from the group consisting of Image Set Selection Rules,View and Viewport Selection Rules, and Display Protocol Selection Rules.

Yet further aspects include methods where the step of identifying one ormore Image Set Selection Rules is based on the one or more Image SetSelection Parameters.

Still further aspects include methods where the step of selecting one ormore Viewpoint Selection Rules is based on one or more View and ViewportSelection Parameters.

Other aspects include methods where the step of displaying the one ormore Sets of Images is based on one or more Display Protocol SelectionRules, one or more Image Set Selection Rules, and one or more View andViewport Selection Rules.

Still other aspects include methods where one or more of the StudySelection Parameters are selected from the group consisting of DICOMparameters and Abstract Tags.

Other aspects include methods where one or more of the Display ProtocolSelection Parameters are selected from the group consisting of DICOMparameters and Abstract Tags.

Additional aspects include methods where one or more of the Image SetSelection Parameters are selected from the group consisting of DICOMparameters and Abstract Tags.

Further aspects include methods where one or more of the View andViewport Selection Parameters are selected from the group consisting ofDICOM parameters and Abstract Tags.

More aspects include methods where one or more Study SelectionParameters are derived from a single reference image.

Still more aspects include methods where one or more Study SelectionParameters are derived from a single reference image DICOM Parameters.

Yet other aspects include methods where one or more Display ProtocolSelection Parameters are derived using a list of all values of a DICOMparameter occurring in any of the one or more Sets of Images.

Alternative aspects include methods where the one or more View andViewport Selection Rules contain protocols for one or more Viewportsdisplaying images as 2D.

Other alternative aspects include methods where the one or more View andViewport Selection Rules contain protocols for one or more Viewportsdisplaying images in a 3D rendering mode.

Further alternative aspects include methods where one or more StudySelection Parameters include one or more Abstract Tags selected from thegroup consisting of RelativeStudyAge, PriorIndex. NumImages, NumSeries,Num3DVolumes, Num4DSequences and HasReport.

In other aspects, this invention includes methods where one or more Viewand Viewport Selection Rules include one or more Abstract Tags selectedfrom the group consisting of Image Sets to be displayed, RenderingStyle, Additional image sets for image fusion, Image Alignment,Colormap/Transfer Function, Slice Thickness, Zoom Factor, Cameraposition, Camera orientation and Labels/Overlay elements.

In still other aspects, this invention comprises receiving one or moreSets of Images based on the Study Selection Rules, selecting one or moreImage Set Selection Parameters, selecting one or more Image SetSelection Rules based on the one or more Image Set Selection Parametersand displaying the one or more Sets of Images based on the DisplayProtocol Selection Rules and the Image Set Selection Rules.

In another aspect, this invention comprises selecting one or more StudySelection Parameters, selecting or more Study Selection Rules based onthe one or more Study Selection Parameters, receiving one or more Setsof Images based on the Study Selection Rules, selecting one or moreDisplay Protocol Selection Parameters based on the one or more Sets ofImages selected, selecting one or more Display Protocol Selection Rulesbased on the one or more Display Protocol Selection Parameters anddisplaying the one or more Sets of Images based on the Display ProtocolSelection Rules.

Another aspect of this invention comprises selecting one or more StudySelection Parameters, selecting Study Selection Rules based on the oneor more Study Selection Parameters, receiving one or more images basedon the Study Selection Rules, selecting one or more Display ProtocolSelection Parameters based on the one or more images selected, selectingDisplay Protocol Selection Rules based on the one or more DisplayProtocol Selection Parameters, selecting one or more Image Set SelectionParameters, selecting Image Set Selection Rules based on the one or moreImage Set Selection Parameters, selecting one or more View and ViewportSelection Parameters, selecting View and Viewport Selection Rules basedon the one or more View and Viewport Selection Parameters and displayingthe one or more images based on the Display Protocol Selection Rules,the Image Set Selection Rules and the View and Viewport Selection Rules.

Other aspects of the invention include methods where the Study SelectionRule is: IF (Primary.Dicom.BodyPartExamined=‘CHEST’ andPrimary.Dicom.Modality=‘CR’) THEN SELECT other studies for loading WHERE(Other.Dicom. BodyPartExamined=‘CHEST’ and (Other.Dicom.Modality=‘CR’ orOther.Dicom.Modality=‘CT’)).

In another aspect, this invention includes methods where the StudySelection Rule is: IF (Primary.Dicom.BodyPartExamined=‘CHEST’ andPrimary.DicomList.Modality contains ‘CR’) THEN SELECT other studies forloading WHERE (Other.Dicom.BodyPartExamined=‘CHEST’ and(Other.DicomList.Modality contains ‘CR’ or Other.DicomList.Modalitycontains ‘CT’)).

In other aspects, this invention includes methods where the StudySelection Rule is IF (Primary.Dicom.Modality=‘MG’ THEN SELECT otherstudies for loading WHERE (Other.Dicom.Modality=‘MG’ andOther.Abstract.Priorindex<=3 and Other.Abstract.RelativeStudyAge<5*365).

In yet another aspect, this invention includes methods where theProtocol Selection Rule is IF (Primary.Dicom.BodyPartExamined=‘ABDOMEN’and Primary.Dicom.Modality=‘CT’ and Exists(Other1) andOther1.Dicom.Modality=‘PET’) THEN SELECT ‘StandardPetCTProtocol1’ withscore=10.

In aspects of the invention, methods include an Image Set Rule IF(Dicom.Modality=‘CT’ and Abstract.Priorindex=0) THEN CREATE image setwith ID 1.

Additionally, other aspects include methods where the Image Set Rule is:IF (Dicom.Modality=‘CT’ and Abstract.Priorindex=0) THEN CREATE image setwith ID 1, SORTED BY Dicom.SeriesNumber ORDER:=ascending, SORTED BYDicom.InstanceNumber ORDER:=ascending.

Still other aspects include methods where the Image Set Rule is IF(Dicom.Modality=‘CT’ and Abstract.Priorindex=0) THEN CREATE image setwith ID 1.x, SORTED BY Dicom.SeriesNumber ORDER:=ascending SPLIT:=true,SORTED BY Dicom.InstanceNumber ORDER:=ascending SPLIT:=false.

Moreover, other aspects include methods where the Image Set Rule is IF(Dicom.Modality=‘CT’ and Abstract.Priorindex=0) THEN CREATE image setwith ID 1.x, SORTED BY Condition.CTSoftTisseKernel SPLIT:=true, SORTEDBY Dicom.SeriesNumber ORDER:=ascending SPLIT:=true, SORTED BYDicom.InstanceNumber ORDER:=ascending SPLIT:=false.

Yet other aspects include methods where the Image Set Rule (Localizer)is IF (Dicom.Modality=‘CT’ and Condition.IsLocalizer=true) THEN CREATEimage set with ID 1, SORTED BY Dicom.SeriesNumber ORDER:=ascendingSPLIT:=true, SORTED BY Dicom.InstanceNumber ORDER:=ascendingSPLIT:=false.

Other aspects of the methods of this invention include an Image Set Rule(Images) IF (Dicom.Modality=‘CT’ and Abstract.AlreadyReferenced=false)THEN CREATE image set with ID 2, SORTED BY Dicom.SeriesNumberORDER:=ascending SPLIT:=true, SORTED BY Dicom.InstanceNumberORDER:=ascending SPLIT:=false.

Yet other aspects of the methods of this invention include using ImageSet Rule (Images), IF (Dicom.Modality=‘CT’ andAbstract.AlreadyReferenced=false) THEN CREATE image set with ID 2,SORTED BY Dicom.SeriesNumber ORDER:=ascending SPLIT:=true, SORTED BYDicom.InstanceNumber ORDER:=ascending SPLIT:=false.

Additionally, other aspects include methods where the Display Parametersinclude Viewer Assignment Rule IF (Abstract.ImageSetID=1), THEN SELECTimage set with score=10.

Yet further aspects include methods where the Display Parameters includea Viewer Assignment Rule IF (Abstract.ImageSetID=2) THEN SELECT imageset with score=5.

Additional aspects include methods further comprising a ViewerAssignment Rule IF (Abstract.ImageSetID=2) THEN SELECT image set withscore=5.

In other aspects of this invention, methods include one or more StudySelection Rules comprising one or more Abstract Tags selected from thegroup consisting of RelativeStudyAge indicates relative age of Study indays compared to primary Study 1105, PriorIndex indicates an index thatenumerates all other studies from youngest to oldest, NumImagesindicates number of images in Study, NumSeries indicated number of imageseries in Study, Num3DVolumes indicates number of 3D volumes in Study,Num4DSequences indicates number of 4D sequences in Study (e.g. CardiacCT), and HasReport indicates a flag that indicates if a report isavailable for a Study, IsThinSliceVolume.

Aspects of methods also include a step of displaying including use of anAbstract Tag DisplaySetID.

Other aspects of methods include Abstract Tag DisplaySetID having aStyle Rule selected from the group consisting of Rendering style (can be2D, oblique, curved, MIP slab, 3D MIP, VRT, shaded VRT, etc.), Imagealignment (left, right, top, bottom, centered), Inverse display (blackon white versus white on black), Colormap or transfer function,Window/level (data window), Slice thickness, Zoom factor, Cameraposition and orientation; and Labels/OverlayDisplay of labels,annotations and other overlay elements.

Still other methods include steps where the Style Rule is IF(Abstract.DisplaySetID>100 and Abstract.DisplaySetID<105 andDicom.Modality=TT′) THEN SET RenderingStyle:=‘3D MIP’, Inverse:=true,DataWindow:=‘2% 98%’.

Other aspects of methods include use of a Style Rule IF(Abstract.ImageSetID=200) THEN SET RenderingStyle:=‘MPR’,SliceThickness:=‘20’, DataWindow:=‘DICOM1’, andZoomFactor:=‘FitToWindow’,

Another aspect of the present invention is a method of displaying one ormore Sets of Images comprises selecting one or more Study SelectionParameters, identifying one or more Study Selection Rules based on theone or more Study Selection Parameters, selecting one or more Sets ofImages from a plurality of images based on the one or more StudySelection Rules, selecting one or more Display Protocol SelectionParameters based on the one or more Sets of Images selected, identifyingone or more Display Protocol Selection Rules based on the one or moreDisplay Protocol Selection Parameters, using the one or more DisplayProtocol Selection Rules to select one or more Display Parameters anddisplaying the one or more Sets of Images according to the DisplayParameters.

Still other aspects of methods of displaying one or more Sets of Imagescomprising the steps of selecting one or more Study SelectionParameters, selecting Study Selection Rules based on the one or moreStudy Selection Parameters, selecting one or more Sets of Images basedon the Study Selection Rules, selecting one or more Display ProtocolSelection Parameters based on the one or more Sets of Images selected,selecting Display Protocol Selection Rules based on the one or moreDisplay Protocol Selection Parameters, selecting one or more Image SetSelection Parameters, selecting Image Set Selection Rules based on theone or more Image Set Selection Parameters, selecting one or more Viewand Viewport Selection Parameters, selecting View and Viewport SelectionRules based on the one or more View and Viewport Selection Parametersand displaying the one or more Sets of Images based on the DisplayProtocol Selection Rules, the Image Set Selection Rules and the View andViewport Selection Rules.

In systems of this invention, aspects include system for displaying oneor more Sets of Images comprises selecting one or more Study SelectionParameters, selecting one or more Study Selection Rules based on the oneor more Study Selection Parameters, receiving one or more Sets of Imagesbased on the Study Selection Rules, selecting one or more DisplayProtocol Selection Parameters based on the one or more Sets of Imagesselected, selecting Display Protocol Selection Rules based on the one ormore Display Protocol Selection Parameters, selecting one or more ImageSet Selection Parameters, selecting one or more Image Set SelectionRules based on the one or more Image Set Selection Parameters, selectingone or more View and Viewport Selection Parameters, selecting View andViewport Selection Rules based on the one or more View and ViewportSelection Parameters and graphics resources for displaying the one ormore Sets of Images based on one or more of Display Protocol SelectionRules, Image Set Selection Rules, the View and Viewport Selection Rules,and Viewer Assignment Rules.

Additional system aspects include Sets of Images comprises one or moredigital data processors for carrying out the steps according to any ofthe above described methods aspects and graphics resources fordisplaying the one or more Sets of Images.

In an embodiment of the invention, a method of displaying imagescomprises selecting one or more Study Selection Parameters, identifyingStudy Selection Rules based on the one or more Study SelectionParameters, receiving one or more images based on the Study SelectionRules, selecting one or more Display Protocol Selection Parameters basedon the one or more images selected, identifying Display ProtocolSelection Rules based on the one or more Display Protocol SelectionParameters, selecting one or more Image Set Selection Parameters,identifying Image Set Selection Rules based on the one or more Image SetSelection Parameters, selecting one or more View and Viewport SelectionParameters, identifying View and Viewport Selection Rules based on theone or more View and Viewport Selection Parameters and displaying theone or more images based on the Display Protocol Selection Rules, theImage Set Selection Rules and the View and Viewport Selection Rules.

In another embodiment of the invention, a method of displaying imagescomprises selecting one or more Study Selection Parameters, identifyinga Study Selection Rule based on the one or more Study SelectionParameters, where the Study Selection Rule is: IF(Primary.Dicom.BodyPartExamined=‘CHEST’ and Primary.Dicom.Modality=‘CR’)THEN SELECT other studies for loading WHERE (Other.Dicom.BodyPartExamined=‘CHEST’ and (Other.Dicom.Modality=‘CR’ orOther.Dicom.Modality=‘CT’)), receiving one or more images based on theStudy Selection Rules, selecting one or more Display Protocol SelectionParameters based on the one or more images selected, identifying DisplayProtocol Selection Rules based on the one or more Display ProtocolSelection Parameters, selecting one or more Image Set SelectionParameters, identifying Image Set Selection Rules based on the one ormore Image Set Selection Parameters. selecting one or more View andViewport Selection Parameters, identifying View and Viewport SelectionRules based on the one or more View and Viewport Selection Parametersand displaying the one or more images based on the Display ProtocolSelection Rules, the Image Set Selection Rules and the View and ViewportSelection Rules.

In an alternative embodiment of the invention, a method of displayingimages comprises selecting one or more Study Selection Parameters,identifying a Study Selection Rule based on the one or more StudySelection Parameters, where the Study Selection Rule is IF(Primary.Dicom.BodyPartExamined=‘CHEST’ and Primary.DicomList.Modalitycontains ‘CR’) THEN SELECT other studies for loading WHERE(Other.Dicom.BodyPartExamined=‘CHEST’ and (Other.DicomList.Modalitycontains ‘CR’ or Other.DicomList.Modality contains ‘CT’)), receiving oneor more images based on the Study Selection Rules, selecting one or moreDisplay Protocol Selection Parameters based on the one or more imagesselected, identifying Display Protocol Selection Rules based on the oneor more Display Protocol Selection Parameters, selecting one or moreImage Set Selection Parameters, identifying Image Set Selection Rulesbased on the one or more Image Set Selection Parameters, selecting oneor more View and Viewport Selection Parameters, identifying View andViewport Selection Rules based on the one or more View and ViewportSelection Parameters and displaying the one or more images based on theDisplay Protocol Selection Rules, the Image Set Selection Rules and theView and Viewport Selection Rules.

In another alternative embodiment of the invention, a method ofdisplaying images comprises selecting one or more Study SelectionParameters, identifying a Study Selection Rule based on the one or moreStudy Selection Parameters, where the Study Selection Rule is IF(Primary.Dicom.Modality=‘MG’ THEN SELECT other studies for loading WHERE(Other.Dicom.Modality=‘MG’ and Other.Abstract.Priorindex<=3 andOther.Abstract.RelativeStudyAge<5*365), receiving one or more imagesbased on the Study Selection Rules, selecting one or more DisplayProtocol Selection Parameters based on the one or more images selected,identifying Display Protocol Selection Rules based on the one or moreDisplay Protocol Selection Parameters, selecting one or more Image SetSelection Parameters, identifying Image Set Selection Rules based on theone or more Image Set Selection Parameters; selecting one or more Viewand Viewport Selection Parameters, identifying View and ViewportSelection Rules based on the one or more View and Viewport SelectionParameters and displaying the one or more images based on the DisplayProtocol Selection Rules, the Image Set Selection Rules and the View andViewport Selection Rules.

In an embodiment of the invention, a method of displaying imagescomprises selecting one or more Study Selection Parameters, identifyingStudy Selection Rules based on the one or more Study SelectionParameters, receiving one or more images based on the Study SelectionRules, selecting one or more Display Protocol Selection Parameters basedon the one or more images selected, identifying a Display ProtocolSelection Rule based on the one or more Display Protocol SelectionParameters, where the Display Protocol Selection Rule is IF(Primary.Dicom.BodyPartExamined=‘ABDOMEN’ andPrimary.Dicom.Modality=‘CT’ and Exists(Other1) andOther1.Dicom.Modality=‘PET’) THEN SELECT ‘StandardPetCTProtocol1’ withscore=10, selecting one or more Image Set Selection Parameters,identifying Image Set Selection Rules based on the one or more Image SetSelection Parameters, selecting one or more View and Viewport SelectionParameters, identifying View and Viewport Selection Rules based on theone or more View and Viewport Selection Parameters and displaying theone or more images based on the Display Protocol Selection Rules, theImage Set Selection Rules and the View and Viewport Selection Rules.

In a further embodiment of the invention, a method of displaying imagescomprises selecting one or more Study Selection Parameters, identifyingStudy Selection Rules based on the one or more Study SelectionParameters, receiving one or more images based on the Study SelectionRules, selecting one or more Display Protocol Selection Parameters basedon the one or more images selected, identifying Display ProtocolSelection Rules based on the one or more Display Protocol SelectionParameters, selecting one or more Image Set Selection Parameters,identifying an Image Set Selection Rule based on the one or more ImageSet Selection Parameters, where the Image Set Selection Rule (Localizer)is IF (Dicom.Modality=‘CT’ and Abstract.AlreadyReferenced=false) THENCREATE image set with ID 2, SORTED BY Dicom.SeriesNumberORDER:=ascending SPLIT:=true, SORTED BY Dicom.InstanceNumberORDER:=ascending SPLIT:=false; selecting one or more View and ViewportSelection Parameters, identifying View and Viewport Selection Rulesbased on the one or more View and Viewport Selection Parameters anddisplaying the one or more images based on the Display ProtocolSelection Rules, the Image Set Selection Rules and the View and ViewportSelection Rules.

In another embodiment of the invention, a method of displaying imagescomprises selecting one or more Study Selection Parameters, identifyingStudy Selection Rules based on the one or more Study SelectionParameters, receiving one or more images based on the Study SelectionRules, selecting one or more Display Protocol Selection Parameters basedon the one or more images selected, where the one or more DisplayProtocol Selection Parameters include Viewer Assignment Rule IF(Abstract.ImageSetID=1) THEN SELECT image set with score=10; identifyingDisplay Protocol Selection Rules based on the one or more DisplayProtocol Selection Parameters, selecting one or more Image Set SelectionParameters; identifying Image Set Selection Rules based on the one ormore Image Set Selection Parameters, selecting one or more View andViewport Selection Parameters, identifying View and Viewport SelectionRules based on the one or more View and Viewport Selection Parametersand displaying the one or more images based on the Display ProtocolSelection Rules, the Image Set Selection Rules and the View and ViewportSelection Rules.

In an additional embodiment of the invention, a method of displayingimages comprises selecting one or more Study Selection Parameters,identifying Study Selection Rules based on the one or more StudySelection Parameters, receiving one or more images based on the StudySelection Rules, selecting one or more Display Protocol SelectionParameters based on the one or more images selected, where the one ormore Display Protocol Selection Parameters include Viewer AssignmentRule IF (Abstract.ImageSetID=1) THEN SELECT image set with score=10,identifying Display Protocol Selection Rules based on the one or moreDisplay Protocol Selection Parameters, selecting one or more Image SetSelection Parameters; identifying Image Set Selection Rules based on theone or more Image Set Selection Parameters, selecting one or more Viewand Viewport Selection Parameters, identifying View and ViewportSelection Rules based on the one or more View and Viewport SelectionParameters and displaying the one or more images based on the DisplayProtocol Selection Rules, the Image Set Selection Rules and the View andViewport Selection Rules.

In a further embodiment of the invention, a method of displaying imagescomprises selecting one or more Study Selection Parameters, identifyingStudy Selection Rules based on the one or more Study SelectionParameters, receiving one or more images based on the Study SelectionRules, selecting one or more Display Protocol Selection Parameters basedon the one or more images selected, where the one or more DisplayProtocol Selection Parameters include Viewer Assignment Rule IF(Abstract.ImageSetID=2) THEN SELECT image set with score=5, identifyingDisplay Protocol Selection Rules based on the one or more DisplayProtocol Selection Parameters, selecting one or more Image Set SelectionParameters, identifying Image Set Selection Rules based on the one ormore Image Set Selection Parameters; selecting one or more View andViewport Selection Parameters, identifying View and Viewport SelectionRules based on the one or more View and Viewport Selection Parametersand displaying the one or more images based on the Display ProtocolSelection Rules, the Image Set Selection Rules and the View and ViewportSelection Rules.

In a still further embodiment of the invention, a method of displayingimages comprises selecting one or more Study Selection Parameters,identifying Study Selection Rules based on the one or more StudySelection Parameters, receiving one or more images based on the StudySelection Rules, selecting one or more Display Protocol SelectionParameters based on the one or more images selected, identifying DisplayProtocol Selection Rules based on the one or more Display ProtocolSelection Parameters, selecting one or more Image Set SelectionParameters, identifying Image Set Selection Rules based on the one ormore Image Set Selection Parameters, selecting one or more View andViewport Selection Parameters, identifying View and Viewport SelectionRules based on the one or more View and Viewport Selection Parameters,displaying the one or more images based on the Display ProtocolSelection Rules, the Image Set Selection Rules and the View and ViewportSelection Rules; and selecting Viewer Assignment Rule IF(Abstract.ImageSetID=2) THEN SELECT image set with score=5.

In an embodiment of the invention, a method of displaying imagescomprises selecting one or more Study Selection Parameters, identifyingStudy Selection Rules based on the one or more Study SelectionParameters, where the one or more Study Selection Rules comprise one ormore Abstract Tags selected from the group consisting ofRelativeStudyAge indicates relative age of Study in days compared toprimary Study, PriorIndex indicates an index that enumerates all otherstudies from youngest to oldest, NumImages indicates number of images inStudy, NumSeries indicated number of image series in Study, Num3DVolumesindicates number of 3D volumes in Study, Num4DSequences indicates numberof 4D sequences in Study (e.g. Cardiac CT) and HasReport indicates aflag that indicates if a report is available for a Study; receiving oneor more images based on the Study Selection Rules, selecting one or moreDisplay Protocol Selection Parameters based on the one or more imagesselected, identifying Display Protocol Selection Rules based on the oneor more Display Protocol Selection Parameters selecting one or moreImage Set Selection Parameters, identifying Image Set Selection Rulesbased on the one or more Image Set Selection Parameters, selecting oneor more View and Viewport Selection Parameters, identifying View andViewport Selection Rules based on the one or more View and ViewportSelection Parameters and displaying the one or more images based on theDisplay Protocol Selection Rules, the Image Set Selection Rules and theView and Viewport Selection Rules.

In another embodiment of the invention, a method of displaying imagescomprises selecting one or more Study Selection Parameters, identifyingStudy Selection Rules based on the one or more Study SelectionParameters, receiving one or more images based on the Study SelectionRules, selecting one or more Display Protocol Selection Parameters basedon the one or more images selected, identifying Display ProtocolSelection Rules based on the one or more Display Protocol SelectionParameters, selecting one or more Image Set Selection Parameters,identifying Image Set Selection Rules based on the one or more Image SetSelection Parameters, selecting one or more View and Viewport SelectionParameters, identifying View and Viewport Selection Rules based on theone or more View and Viewport Selection Parameters and displaying theone or more images based on the Display Protocol Selection Rules, theImage Set Selection Rules and the View and Viewport Selection Rules,where the step of displaying includes an Abstract Tag DisplaySetID.

In another embodiment of the invention, a method of displaying imagescomprises selecting one or more Study Selection Parameters, identifyingStudy Selection Rules based on the one or more Study SelectionParameters, receiving one or more images based on the Study SelectionRules, selecting one or more Display Protocol Selection Parameters basedon the one or more images selected, identifying Display ProtocolSelection Rules based on the one or more Display Protocol SelectionParameters, selecting one or more Image Set Selection Parameters,identifying Image Set Selection Rules based on the one or more Image SetSelection Parameters, selecting one or more View and Viewport SelectionParameters, identifying View and Viewport Selection Rules based on theone or more View and Viewport Selection Parameters and displaying theone or more images based on the Display Protocol Selection Rules, theImage Set Selection Rules and the View and Viewport Selection Rules,where the step of displaying includes an Abstract Tag DisplaySetID,where the Abstract Tag DisplaySetID has a Style Rule selected from thegroup consisting of Rendering style (can be 2D, oblique, curved, MIPslab, 3D MIP, VRT, shaded VRT, etc.), Image alignment (left, right, top,bottom, centered), Inverse display (black on white versus white onblack), Colormap or transfer function, Window/level (data window), Slicethickness, Zoom factor, Camera position and orientation andLabels/OverlayDisplay of labels, annotations and other overlay elements.

In a further embodiment of the invention, a method of displaying imagescomprises selecting one or more Study Selection Parameters, identifyingStudy Selection Rules based on the one or more Study SelectionParameters, receiving one or more images based on the Study SelectionRules, selecting one or more Display Protocol Selection Parameters basedon the one or more images selected, identifying Display ProtocolSelection Rules based on the one or more Display Protocol SelectionParameters, selecting one or more Image Set Selection Parameters,identifying Image Set Selection Rules based on the one or more Image SetSelection Parameters, selecting one or more View and Viewport SelectionParameters, identifying View and Viewport Selection Rules based on theone or more View and Viewport Selection Parameters an displaying the oneor more images based on the Display Protocol Selection Rules, the ImageSet Selection Rules and the View and Viewport Selection Rules, where thestep of displaying includes an Abstract Tag DisplaySetID, where theAbstract Tag DisplaySetID has a Style Rule selected from the groupconsisting of Rendering style (can be 2D, oblique, curved, MIP slab, 3DMIP, VRT, shaded VRT, etc.), Image alignment (left, right, top, bottom,centered), Inverse display (black on white versus white on black),Colormap or transfer function, Window/level (data window), Slicethickness, Zoom factor, Camera position and orientation andLabels/OverlayDisplay of labels, annotations and other overlay elements;where the Style Rule is IF (Abstract.DisplaySetID>100 andAbstract.DisplaySetID<105 and Dicom.Modality=TT′) THEN SETRenderingStyle:=‘3D MIP’, Inverse:=true and DataWindow:=‘2% 98%’.

In a still further embodiment of the invention, a method of displayingimages comprises selecting one or more Study Selection Parameters,identifying Study Selection Rules based on the one or more StudySelection Parameters, receiving one or more images based on the StudySelection Rules, selecting one or more Display Protocol SelectionParameters based on the one or more images selected, identifying DisplayProtocol Selection Rules based on the one or more Display ProtocolSelection Parameters, selecting one or more Image Set SelectionParameters, identifying Image Set Selection Rules based on the one ormore Image Set Selection Parameters, selecting one or more View andViewport Selection Parameters, identifying View and Viewport SelectionRules based on the one or more View and Viewport Selection Parametersand displaying the one or more images based on the Display ProtocolSelection Rules, the Image Set Selection Rules and the View and ViewportSelection Rules, where the step of displaying includes an Abstract TagDisplaySetID, where the Abstract Tag DisplaySetID has a Style Ruleselected from the group consisting of Rendering style (can be 2D,oblique, curved, MIP slab, 3D MIP, VRT, shaded VRT, etc.), Imagealignment (left, right, top, bottom, centered), Inverse display (blackon white versus white on black), Colormap or transfer function,Window/level (data window), Slice thickness, Zoom factor, Cameraposition and orientation and Labels/OverlayDisplay of labels,annotations and other overlay elements; where the Style Rule is IF(Abstract.ImageSetID=200) THEN SET RenderingStyle:=‘MPR’,SliceThickness:=‘20’, DataWindow:=‘DICOM1’ andZoomFactor:=‘FitToWindow’.

In an embodiment of the invention, a method of displaying one or moreSets of Images comprises selecting one or more Study SelectionParameters, selecting or more Study Selection Rules based on the one ormore Study Selection Parameters, receiving one or more Sets of Imagesbased on the Study Selection Rules, selecting one or more DisplayProtocol Selection Parameters based on the one or more Sets of Imagesselected, selecting one or more Display Protocol Selection Rules basedon the one or more Display Protocol Selection Parameters and displayingthe one or more Sets of Images based on the Display Protocol SelectionRules.

In a further embodiment of the invention, a method of displaying one ormore Sets of Images comprises selecting a primary Study, selecting oneor more Study Selection Parameters based on the primary Study, selectingone or more Study Selection Rules based on the one or more StudySelection Parameters, selecting one or more Sets of Images from aplurality of images based on the one or more Study Selection Rules,selecting one or more Display Protocol Selection Parameters based on theone or more Sets of Images selected, selecting one or more DisplayProtocol Selection Rules based on the one or more Display ProtocolSelection Parameters, selecting one or more Display Parameters using theone or more Display Protocol Selection Rules, where the one or moreDisplay Parameter are selected from the group consisting of Image SetSelection Parameters and View and Viewport Selection Parameters anddisplaying the one or more Sets of Images according to the DisplayParameters.

In an embodiment of the invention, a system of displaying one or moreSets of Images from a plurality of images comprises a processor capableof selecting a primary Study from a plurality of studies, one or moredigital data processors capable of carrying out the steps includingapplying one or more Study Selection Rules to generate a plurality ofsecond studies based on one or more DICOM parameters and one or moreAbstract Tags from the primary Study and one or more DICOM parametersand one or more Abstract Tags from the plurality of studies, where theplurality of second studies include the primary Study, applying one ormore Protocol Selection Rules to select a Display Protocol, where theone or more Protocol Selection Rules are based on one or more DICOMparameters and one or more Abstract Tags from the plurality of secondstudies, applying one or more Image Set Rules to define a plurality ofImage Sets from the plurality of second studies, applying one or moreViewport Assignment Rules to assign one or more Image Sets from theplurality of Image Sets to one or more Viewports defined in the DisplayProtocol, applying one or more Style Rules to define a rendering styleand rendering parameters of the one or more Viewports and graphicsresources for displaying the plurality of Image Sets based on one ormore of the one or more Protocol Selection Rules, the one or more ImageSet Rules, the one or more Viewport Assignment Rules, and the one ormore Style Rules.

In an embodiment of the invention, a system of displaying one or moreSets of Images from a plurality of images comprises a processor capableof selecting a primary Study from a plurality of studies, one or moredigital data processors capable of carrying out the steps includingapplying one or more Study Selection Rules to generate a plurality ofsecond studies based on one or more DICOM parameters and one or moreAbstract Tags from the primary Study and one or more DICOM parametersand one or more Abstract Tags from the plurality of studies, where theplurality of second studies include the primary Study, applying one ormore Protocol Selection Rules to select a Display Protocol, where theone or more Protocol Selection Rules are based on one or more DICOMparameters and one or more Abstract Tags from the plurality of secondstudies, applying one or more Image Set Rules to define a plurality ofImage Sets from the plurality of second studies, applying one or moreViewport Assignment Rules to assign one or more Image Sets from theplurality of Image Sets to one or more Viewports defined in the DisplayProtocol, applying one or more Style Rules to define a rendering styleand rendering parameters of the one or more Viewports and graphicsresources for displaying the plurality of Image Sets based on one ormore of the one or more Protocol Selection Rules, the one or more ImageSet Rules, the one or more Viewport Assignment Rules, and the one ormore Style Rules, where at least one study from the plurality of ImageSets is a two dimensional image.

In an embodiment of the invention, a system of displaying one or moreSets of Images from a plurality of images comprises a processor capableof selecting a primary Study from a plurality of studies, one or moredigital data processors capable of carrying out the steps includingapplying one or more Study Selection Rules to generate a plurality ofsecond studies based on one or more DICOM parameters and one or moreAbstract Tags from the primary Study and one or more DICOM parametersand one or more Abstract Tags from the plurality of studies, where theplurality of second studies include the primary Study, applying one ormore Protocol Selection Rules to select a Display Protocol, where theone or more Protocol Selection Rules are based on one or more DICOMparameters and one or more Abstract Tags from the plurality of secondstudies, applying one or more Image Set Rules to define a plurality ofImage Sets from the plurality of second studies, applying one or moreViewport Assignment Rules to assign one or more Image Sets from theplurality of Image Sets to one or more Viewports defined in the DisplayProtocol, applying one or more Style Rules to define a rendering styleand rendering parameters of the one or more Viewports and graphicsresources for displaying the plurality of Image Sets based on one ormore of the one or more Protocol Selection Rules, the one or more ImageSet Rules, the one or more Viewport Assignment Rules, and the one ormore Style Rules, where at least one study from the plurality of ImageSets is a three dimensional (3D) image displayed with a 3D renderingstyle.

In an embodiment of the invention, a system of displaying one or moreSets of Images from a plurality of images comprises a processor capableof selecting a primary Study from a plurality of studies, one or moredigital data processors capable of carrying out the steps includingapplying one or more Study Selection Rules to generate a plurality ofsecond studies based on one or more DICOM parameters and one or moreAbstract Tags from the primary Study and one or more DICOM parametersand one or more Abstract Tags from the plurality of studies, where theplurality of second studies include the primary Study, applying one ormore Protocol Selection Rules to select a Display Protocol, where theone or more Protocol Selection Rules are based on one or more DICOMparameters and one or more Abstract Tags from the plurality of secondstudies, applying one or more Image Set Rules to define a plurality ofImage Sets from the plurality of second studies, applying one or moreViewport Assignment Rules to assign one or more Image Sets from theplurality of Image Sets to one or more Viewports defined in the DisplayProtocol, applying one or more Style Rules to define a rendering styleand rendering parameters of the one or more Viewports and graphicsresources for displaying the plurality of Image Sets based on one ormore of the one or more Protocol Selection Rules, the one or more ImageSet Rules, the one or more Viewport Assignment Rules, and the one ormore Style Rules, where at least one of the one or more Viewportsdisplays an oblique cross section through a volumetric image set.

In an embodiment of the invention, a system of displaying one or moreSets of Images from a plurality of images comprises a processor capableof selecting a primary Study from a plurality of studies, one or moredigital data processors capable of carrying out the steps includingapplying one or more Study Selection Rules to generate a plurality ofsecond studies based on one or more DICOM parameters and one or moreAbstract Tags from the primary Study and one or more DICOM parametersand one or more Abstract Tags from the plurality of studies, where theplurality of second studies include the primary Study, applying one ormore Protocol Selection Rules to select a Display Protocol, where theone or more Protocol Selection Rules are based on one or more DICOMparameters and one or more Abstract Tags from the plurality of secondstudies, applying one or more Image Set Rules to define a plurality ofImage Sets from the plurality of second studies, applying one or moreViewport Assignment Rules to assign one or more Image Sets from theplurality of Image Sets to one or more Viewports defined in the DisplayProtocol, applying one or more Style Rules to define a rendering styleand rendering parameters of the one or more Viewports and graphicsresources for displaying the plurality of Image Sets based on one ormore of the one or more Protocol Selection Rules, the one or more ImageSet Rules, the one or more Viewport Assignment Rules, and the one ormore Style Rules, where at least one of the one or more Viewportsdisplays a maximum intensity projection of an image set.

In an embodiment of the invention, a system of displaying one or moreSets of Images from a plurality of images comprises a processor capableof selecting a primary Study from a plurality of studies, one or moredigital data processors capable of carrying out the steps includingapplying one or more Study Selection Rules to generate a plurality ofsecond studies based on one or more DICOM parameters and one or moreAbstract Tags from the primary Study and one or more DICOM parametersand one or more Abstract Tags from the plurality of studies, where theplurality of second studies include the primary Study, applying one ormore Protocol Selection Rules to select a Display Protocol, where theone or more Protocol Selection Rules are based on one or more DICOMparameters and one or more Abstract Tags from the plurality of secondstudies, applying one or more Image Set Rules to define a plurality ofImage Sets from the plurality of second studies, applying one or moreViewport Assignment Rules to assign one or more Image Sets from theplurality of Image Sets to one or more Viewports defined in the DisplayProtocol, applying one or more Style Rules to define a rendering styleand rendering parameters of the one or more Viewports and graphicsresources for displaying the plurality of Image Sets based on one ormore of the one or more Protocol Selection Rules, the one or more ImageSet Rules, the one or more Viewport Assignment Rules, and the one ormore Style Rules, where at least one of the one or more Viewportsdisplays a post processed rendering of an image set.

In an embodiment of the invention, a system of displaying one or moreSets of Images from a plurality of images comprises a processor capableof selecting a primary Study from a plurality of studies, one or moredigital data processors capable of carrying out the steps includingapplying one or more Study Selection Rules to generate a plurality ofsecond studies based on one or more DICOM parameters and one or moreAbstract Tags from the primary Study and one or more DICOM parametersand one or more Abstract Tags from the plurality of studies, where theplurality of second studies include the primary Study, applying one ormore Protocol Selection Rules to select a Display Protocol, where theone or more Protocol Selection Rules are based on one or more DICOMparameters and one or more Abstract Tags from the plurality of secondstudies, applying one or more Image Set Rules to define a plurality ofImage Sets from the plurality of second studies, applying one or moreViewport Assignment Rules to assign one or more Image Sets from theplurality of Image Sets to one or more Viewports defined in the DisplayProtocol, applying one or more Style Rules to define a rendering styleand rendering parameters of the one or more Viewports and graphicsresources for displaying the plurality of Image Sets based on one ormore of the one or more Protocol Selection Rules, the one or more ImageSet Rules, the one or more Viewport Assignment Rules, and the one ormore Style Rules, where at least one of the one or more Viewportsdisplays a thick slab image.

In an embodiment of the invention, a system of displaying one or moreSets of Images from a plurality of images comprises a processor capableof selecting a primary Study from a plurality of studies, one or moredigital data processors capable of carrying out the steps includingapplying one or more Study Selection Rules to generate a plurality ofsecond studies based on one or more DICOM parameters and one or moreAbstract Tags from the primary Study and one or more DICOM parametersand one or more Abstract Tags from the plurality of studies, where theplurality of second studies include the primary Study, applying one ormore Protocol Selection Rules to select a Display Protocol, where theone or more Protocol Selection Rules are based on one or more DICOMparameters and one or more Abstract Tags from the plurality of secondstudies, applying one or more Image Set Rules to define a plurality ofImage Sets from the plurality of second studies, applying one or moreViewport Assignment Rules to assign one or more Image Sets from theplurality of Image Sets to one or more Viewports defined in the DisplayProtocol, applying one or more Style Rules to define a rendering styleand rendering parameters of the one or more Viewports and graphicsresources for displaying the plurality of Image Sets based on one ormore of the one or more Protocol Selection Rules, the one or more ImageSet Rules, the one or more Viewport Assignment Rules, and the one ormore Style Rules, where at least one of the one or more Viewportsdisplays a volume rendered image.

In an embodiment of the invention, a system of displaying one or moreSets of Images from a plurality of images comprises a processor capableof selecting a primary Study from a plurality of studies, one or moredigital data processors capable of carrying out the steps includingapplying one or more Study Selection Rules to generate a plurality ofsecond studies based on one or more DICOM parameters and one or moreAbstract Tags from the primary Study and one or more DICOM parametersand one or more Abstract Tags from the plurality of studies, where theplurality of second studies include the primary Study, applying one ormore Protocol Selection Rules to select a Display Protocol, where theone or more Protocol Selection Rules are based on one or more DICOMparameters and one or more Abstract Tags from the plurality of secondstudies, applying one or more Image Set Rules to define a plurality ofImage Sets from the plurality of second studies, applying one or moreViewport Assignment Rules to assign one or more Image Sets from theplurality of Image Sets to one or more Viewports defined in the DisplayProtocol, applying one or more Style Rules to define a rendering styleand rendering parameters of the one or more Viewports and graphicsresources for displaying the plurality of Image Sets based on one ormore of the one or more Protocol Selection Rules, the one or more ImageSet Rules, the one or more Viewport Assignment Rules, and the one ormore Style Rules, where at least one of the one or more Viewportsdisplays a three dimensional image.

In an embodiment of the invention, a system of displaying one or moreSets of Images from a plurality of images comprises a processor capableof selecting a primary Study from a plurality of studies, one or moredigital data processors capable of carrying out the steps includingapplying one or more Study Selection Rules to generate a plurality ofsecond studies based on one or more DICOM parameters and one or moreAbstract Tags from the primary Study and one or more DICOM parametersand one or more Abstract Tags from the plurality of studies, where theplurality of second studies include the primary Study, applying one ormore Protocol Selection Rules to select a Display Protocol, where theone or more Protocol Selection Rules are based on one or more DICOMparameters and one or more Abstract Tags from the plurality of secondstudies, applying one or more Image Set Rules to define a plurality ofImage Sets from the plurality of second studies, applying one or moreViewport Assignment Rules to assign one or more Image Sets from theplurality of Image Sets to one or more Viewports defined in the DisplayProtocol, applying one or more Style Rules to define a rendering styleand rendering parameters of the one or more Viewports and graphicsresources for displaying the plurality of Image Sets based on one ormore of the one or more Protocol Selection Rules, the one or more ImageSet Rules, the one or more Viewport Assignment Rules, and the one ormore Style Rules, where one or more Study Selection Rules used DICOMparameters and Abstract Tags derived from a single reference image.

In an embodiment of the invention, a system of displaying one or moreSets of Images from a plurality of images comprises a processor capableof selecting a primary Study from a plurality of studies, one or moredigital data processors capable of carrying out the steps includingapplying one or more Study Selection Rules to generate a plurality ofsecond studies based on one or more DICOM parameters and one or moreAbstract Tags from the primary Study and one or more DICOM parametersand one or more Abstract Tags from the plurality of studies, where theplurality of second studies include the primary Study, applying one ormore Protocol Selection Rules to select a Display Protocol, where theone or more Protocol Selection Rules are based on one or more DICOMparameters and one or more Abstract Tags from the plurality of secondstudies, applying one or more Image Set Rules to define a plurality ofImage Sets from the plurality of second studies, applying one or moreViewport Assignment Rules to assign one or more Image Sets from theplurality of Image Sets to one or more Viewports defined in the DisplayProtocol, applying one or more Style Rules to define a rendering styleand rendering parameters of the one or more Viewports and graphicsresources for displaying the plurality of Image Sets based on one ormore of the one or more Protocol Selection Rules, the one or more ImageSet Rules, the one or more Viewport Assignment Rules, and the one ormore Style Rules, where the primary Study selected is a single referenceimage.

In an embodiment of the invention, a system of displaying one or moreSets of Images from a plurality of images comprises a processor capableof selecting a primary Study from a plurality of studies, one or moredigital data processors capable of carrying out the steps includingapplying one or more Study Selection Rules to generate a plurality ofsecond studies based on one or more DICOM parameters and one or moreAbstract Tags from the primary Study and one or more DICOM parametersand one or more Abstract Tags from the plurality of studies, where theplurality of second studies include the primary Study, applying one ormore Protocol Selection Rules to select a Display Protocol, where theone or more Protocol Selection Rules are based on one or more DICOMparameters and one or more Abstract Tags from the plurality of secondstudies, applying one or more Image Set Rules to define a plurality ofImage Sets from the plurality of second studies, applying one or moreViewport Assignment Rules to assign one or more Image Sets from theplurality of Image Sets to one or more Viewports defined in the DisplayProtocol, applying one or more Style Rules to define a rendering styleand rendering parameters of the one or more Viewports and graphicsresources for displaying the plurality of Image Sets based on one ormore of the one or more Protocol Selection Rules, the one or more ImageSet Rules, the one or more Viewport Assignment Rules, and the one ormore Style Rules, where the primary Study selected is a single referenceimage, where one or more Study Selection Rules are derived from thesingle reference image DICOM Parameters.

In an embodiment of the invention, a system of displaying one or moreSets of Images from a plurality of images comprises a processor capableof selecting a primary Study from a plurality of studies, one or moredigital data processors capable of carrying out the steps includingapplying one or more Study Selection Rules to generate a plurality ofsecond studies based on one or more DICOM parameters and one or moreAbstract Tags from the primary Study and one or more DICOM parametersand one or more Abstract Tags from the plurality of studies, where theplurality of second studies include the primary Study, applying one ormore Protocol Selection Rules to select a Display Protocol, where theone or more Protocol Selection Rules are based on one or more DICOMparameters and one or more Abstract Tags from the plurality of secondstudies, applying one or more Image Set Rules to define a plurality ofImage Sets from the plurality of second studies, applying one or moreViewport Assignment Rules to assign one or more Image Sets from theplurality of Image Sets to one or more Viewports defined in the DisplayProtocol, applying one or more Style Rules to define a rendering styleand rendering parameters of the one or more Viewports and graphicsresources for displaying the plurality of Image Sets based on one ormore of the one or more Protocol Selection Rules, the one or more ImageSet Rules, the one or more Viewport Assignment Rules, and the one ormore Style Rules, where the one or more Viewport Assignment Rulescontain protocols for displaying two dimensional images in the one ormore Viewports.

In an embodiment of the invention, a system of displaying one or moreSets of Images from a plurality of images comprises a processor capableof selecting a primary Study from a plurality of studies, one or moredigital data processors capable of carrying out the steps includingapplying one or more Study Selection Rules to generate a plurality ofsecond studies based on one or more DICOM parameters and one or moreAbstract Tags from the primary Study and one or more DICOM parametersand one or more Abstract Tags from the plurality of studies, where theplurality of second studies include the primary Study, applying one ormore Protocol Selection Rules to select a Display Protocol, where theone or more Protocol Selection Rules are based on one or more DICOMparameters and one or more Abstract Tags from the plurality of secondstudies, applying one or more Image Set Rules to define a plurality ofImage Sets from the plurality of second studies, applying one or moreViewport Assignment Rules to assign one or more Image Sets from theplurality of Image Sets to one or more Viewports defined in the DisplayProtocol, applying one or more Style Rules to define a rendering styleand rendering parameters of the one or more Viewports and graphicsresources for displaying the plurality of Image Sets based on one ormore of the one or more Protocol Selection Rules, the one or more ImageSet Rules, the one or more Viewport Assignment Rules, and the one ormore Style Rules, where the one or more Abstract Tags are selected fromthe group consisting of RelativeStudyAge, PriorIndex. NumImages,NumSeries, Num3DVolumes, Num4DSequences and HasReport.

In an embodiment of the invention, a system of displaying one or moreSets of Images from a plurality of images comprises a processor capableof selecting a primary Study from a plurality of studies, one or moredigital data processors capable of carrying out the steps includingapplying one or more Study Selection Rules to generate a plurality ofsecond studies based on one or more DICOM parameters and one or moreAbstract Tags from the primary Study and one or more DICOM parametersand one or more Abstract Tags from the plurality of studies, where theplurality of second studies include the primary Study, applying one ormore Protocol Selection Rules to select a Display Protocol, where theone or more Protocol Selection Rules are based on one or more DICOMparameters and one or more Abstract Tags from the plurality of secondstudies, applying one or more Image Set Rules to define a plurality ofImage Sets from the plurality of second studies, applying one or moreViewport Assignment Rules to assign one or more Image Sets from theplurality of Image Sets to one or more Viewports defined in the DisplayProtocol, applying one or more Style Rules to define a rendering styleand rendering parameters of the one or more Viewports and graphicsresources for displaying the plurality of Image Sets based on one ormore of the one or more Protocol Selection Rules, the one or more ImageSet Rules, the one or more Viewport Assignment Rules, and the one ormore Style Rules, where the one or more Viewport Assignment Rulesinclude one or more Abstract Tags selected from the group consisting ofImage Sets to be displayed, Rendering Style, Additional image sets forimage fusion, Image Alignment, Colormap/Transfer Function, SliceThickness, Zoom Factor, Camera position, Camera orientation andLabels/Overlay elements.

In an embodiment of the invention, a system of displaying one or moreSets of Images from a plurality of images comprises a processor capableof selecting a primary Study from a plurality of studies, one or moredigital data processors capable of carrying out the steps includingapplying one or more Study Selection Rules to generate a plurality ofsecond studies based on one or more DICOM parameters and one or moreAbstract Tags from the primary Study and one or more DICOM parametersand one or more Abstract Tags from the plurality of studies, where theplurality of second studies include the primary Study, applying one ormore Protocol Selection Rules to select a Display Protocol, where theone or more Protocol Selection Rules are based on one or more DICOMparameters and one or more Abstract Tags from the plurality of secondstudies, applying one or more Image Set Rules to define a plurality ofImage Sets from the plurality of second studies, applying one or moreViewport Assignment Rules to assign one or more Image Sets from theplurality of Image Sets to one or more Viewports defined in the DisplayProtocol, applying one or more Style Rules to define a rendering styleand rendering parameters of the one or more Viewports and graphicsresources for displaying the plurality of Image Sets based on one ormore of the one or more Protocol Selection Rules, the one or more ImageSet Rules, the one or more Viewport Assignment Rules, and the one ormore Style Rules, where the one or more Image Set Rules are selectedfrom selection, sorting, and breaking rules, where the one or more ImageSet Rules are Boolean expressions that contain parameters selected fromthe group consisting of DICOM parameters, abstract tags, andused-defined functions.

In an embodiment of the invention, a system of displaying one or moreSets of Images from a plurality of images comprises a processor capableof selecting a primary Study from a plurality of studies, one or moredigital data processors capable of carrying out the steps includingapplying one or more Study Selection Rules to generate a plurality ofsecond studies based on one or more DICOM parameters and one or moreAbstract Tags from the primary Study and one or more DICOM parametersand one or more Abstract Tags from the plurality of studies, where theplurality of second studies include the primary Study, applying one ormore Protocol Selection Rules to select a Display Protocol, where theone or more Protocol Selection Rules are based on one or more DICOMparameters and one or more Abstract Tags from the plurality of secondstudies, applying one or more Image Set Rules to define a plurality ofImage Sets from the plurality of second studies, applying one or moreViewport Assignment Rules to assign one or more Image Sets from theplurality of Image Sets to one or more Viewports defined in the DisplayProtocol, applying one or more Style Rules to define a rendering styleand rendering parameters of the one or more Viewports and graphicsresources for displaying the plurality of Image Sets based on one ormore of the one or more Protocol Selection Rules, the one or more ImageSet Rules, the one or more Viewport Assignment Rules, and the one ormore Style Rules, where in order to specify image sorting, the Image SetRules contain an ordered list of sorting criteria.

In an embodiment of the invention, a system of displaying one or moreSets of Images from a plurality of images comprises a processor capableof selecting a primary Study from a plurality of studies, one or moredigital data processors capable of carrying out the steps includingapplying one or more Study Selection Rules to generate a plurality ofsecond studies based on one or more DICOM parameters and one or moreAbstract Tags from the primary Study and one or more DICOM parametersand one or more Abstract Tags from the plurality of studies, where theplurality of second studies include the primary Study, applying one ormore Protocol Selection Rules to select a Display Protocol, where theone or more Protocol Selection Rules are based on one or more DICOMparameters and one or more Abstract Tags from the plurality of secondstudies, applying one or more Image Set Rules to define a plurality ofImage Sets from the plurality of second studies, applying one or moreViewport Assignment Rules to assign one or more Image Sets from theplurality of Image Sets to one or more Viewports defined in the DisplayProtocol, applying one or more Style Rules to define a rendering styleand rendering parameters of the one or more Viewports and graphicsresources for displaying the plurality of Image Sets based on one ormore of the one or more Protocol Selection Rules, the one or more ImageSet Rules, the one or more Viewport Assignment Rules, and the one ormore Style Rules, where in order to specify image sorting, the Image SetRules contain an ordered list of sorting criteria, where a split flag isused in order to specify image splitting.

In an embodiment of the invention, a system of displaying one or moreSets of Images from a plurality of images comprises a processor capableof selecting a primary Study from a plurality of studies, one or moredigital data processors capable of carrying out the steps includingapplying one or more Study Selection Rules to generate a plurality ofsecond studies based on one or more DICOM parameters and one or moreAbstract Tags from the primary Study and one or more DICOM parametersand one or more Abstract Tags from the plurality of studies, where theplurality of second studies include the primary Study, applying one ormore Protocol Selection Rules to select a Display Protocol, where theone or more Protocol Selection Rules are based on one or more DICOMparameters and one or more Abstract Tags from the plurality of secondstudies, applying one or more Image Set Rules to define a plurality ofImage Sets from the plurality of second studies, applying one or moreViewport Assignment Rules to assign one or more Image Sets from theplurality of Image Sets to one or more Viewports defined in the DisplayProtocol, applying one or more Style Rules to define a rendering styleand rendering parameters of the one or more Viewports and graphicsresources for displaying the plurality of Image Sets based on one ormore of the one or more Protocol Selection Rules, the one or more ImageSet Rules, the one or more Viewport Assignment Rules, and the one ormore Style Rules, where Abstract Tags are used in Image Set Rules.

In an embodiment of the invention, a system of displaying one or moreSets of Images from a plurality of images comprises a processor capableof selecting a primary Study from a plurality of studies, one or moredigital data processors capable of carrying out the steps includingapplying one or more Study Selection Rules to generate a plurality ofsecond studies based on one or more DICOM parameters and one or moreAbstract Tags from the primary Study and one or more DICOM parametersand one or more Abstract Tags from the plurality of studies, where theplurality of second studies include the primary Study, applying one ormore Protocol Selection Rules to select a Display Protocol, where theone or more Protocol Selection Rules are based on one or more DICOMparameters and one or more Abstract Tags from the plurality of secondstudies, applying one or more Image Set Rules to define a plurality ofImage Sets from the plurality of second studies, applying one or moreViewport Assignment Rules to assign one or more Image Sets from theplurality of Image Sets to one or more Viewports defined in the DisplayProtocol, applying one or more Style Rules to define a rendering styleand rendering parameters of the one or more Viewports and graphicsresources for displaying the plurality of Image Sets based on one ormore of the one or more Protocol Selection Rules, the one or more ImageSet Rules, the one or more Viewport Assignment Rules, and the one ormore Style Rules, where Abstract Tags are used in Image Set Rules, wherean Abstract Tag identifies whether an image has already been placed intoan Image Set.

In an alternative embodiment of the invention, a system of displayingone or more Sets of Images from a plurality of images comprisesselecting one or more studies from a plurality of studies, one or moredigital data processors for carrying out the steps including applyingone or more Protocol Selection Rules to select a Display Protocol, wherethe one or more Protocol Selection Rules are based on one or more DICOMparameters and Abstract Tags from the plurality of studies, applying oneor more Image Set Rules to define a plurality of Image Sets from theplurality of studies, applying one or more Viewport Assignment Rules toassign one or more Image Sets from the plurality of Image Sets to one ormore Viewports defined in the Display Protocol, applying one or moreStyle Rules to define a rendering style and rendering parameters of theone or more Viewports and graphics resources for displaying the one ormore Image Sets based on one or more of the Protocol Selection Rules,the one or more Image Set Rules, the one or more Viewport AssignmentRules, and the one or more Style Rules, where at least one of the one ormore Viewports displays a three dimensional image.

In another alternative embodiment of the invention, a method ofdisplaying one or more Sets of Images from a plurality of imagescomprises selecting a primary Study from a plurality of studies,executing on a server digital data processor a render server programwhich applies one or more of one or more Study Selection Rules, one ormore Protocol Selection Rule, one or more Image Set Rules, one or moreViewport Assignment Rules, and one or more Style Rules to display theone or more Sets of Images including the steps of applying the one ormore Study Selection Rules to generate a plurality of second studiesbased on one or more DICOM parameters and one or more Abstract Tags fromthe primary Study and one or more DICOM parameters and one or moreAbstract Tags from the plurality of studies, where the plurality ofsecond studies include the primary Study, applying the one or moreProtocol Selection Rules to select a Display Protocol, where the one ormore Protocol Selection Rules are based on one or more DICOM parametersand one or more Abstract Tags from the plurality of second studies,applying the one or more Image Set Rules to define a plurality of ImageSets from the plurality of second studies, applying the one or moreViewport Assignment Rules to assign one or more Image Sets from theplurality of Image Sets to one or more Viewports defined in the DisplayProtocol, applying the one or more Style Rules to define a renderingstyle and rendering parameters of the one or more Viewports anddisplaying the one or more Sets of Images in one or more Viewports basedon one or more of the Protocol Selection Rule, the Image Set Rule, theone or more Viewport Assignment Rules, and the one or more Style Rules,where at least one of the one or more Viewports displays a volumerendered image.

In a further embodiment of the invention, a method of displaying one ormore Sets of Images from a plurality of images comprises selecting aprimary Study from a plurality of studies, executing on a server digitaldata processor a render server program which applies one or more of oneor more Study selection Rules, one or more Protocol Selection Rules, oneor more Image Set Rules, one or more Viewport Assignment Rules, and oneor more Style Rules to display the one or more Sets of Images includingthe steps of applying the one or more Study Selection Rules to generatea plurality of second studies based on DICOM parameter BodyPartExamined,DICOM parameter Modality, DICOM parameter RelativeStudyAge and AbstractTag RelativeStudyAge, Abstract Tag PriorIndex, Abstract Tag NumImages,Abstract Tag NumSeries, Abstract Tag Num3DVolumes, Abstract TagNum4DSequences and Abstract Tag HasReport from the plurality of studies,where the plurality of second studies include the primary Study,applying the one or more Protocol Selection Rules to select a DisplayProtocol, where the one or more Protocol Selection Rules are based onDICOM parameter BodyPartExamined, DICOM parameter Modality, DICOMparameter HasThisSliceVolumes, DICOM parameter StudyDescription andAbstract Tags from the plurality of second studies, applying the one ormore Image Set Rules to define a plurality of Image Sets from theplurality of second studies, applying the one or more ViewportAssignment Rules to assign one or more Image Sets from the plurality ofImage Sets to one or more Viewports defined in the Display Protocol,applying the one or more Style Rules to define a rendering style andrendering parameters of the one or more Viewports and displaying the oneor more Sets of Images in one or more Viewports based on one or more ofthe one or more Protocol Selection Rules, the one or more Image SetRules, the one or more Viewport Assignment Rules, and the one or moreStyle Rules, where at least one of the one or more Viewports displays apost processed rendering of an image set.

In a further embodiment of the invention, a method of displaying one ormore Sets of Images from a plurality of images comprises selecting aprimary Study from a plurality of studies, executing on a server digitaldata processor a render server program which applies one or more of oneor more Study selection Rules, one or more Protocol Selection Rules, oneor more Image Set Rules, one or more Viewport Assignment Rules, and oneor more Style Rules to display the one or more Sets of Images includingthe steps of applying the one or more Study Selection Rules to generatea plurality of second studies based on DICOM parameter BodyPartExamined,DICOM parameter Modality, DICOM parameter RelativeStudyAge and AbstractTag RelativeStudyAge, Abstract Tag PriorIndex, Abstract Tag NumImages,Abstract Tag NumSeries, Abstract Tag Num3DVolumes, Abstract TagNum4DSequences and Abstract Tag HasReport from the plurality of studies,where the plurality of second studies include the primary Study,applying the one or more Protocol Selection Rules to select a DisplayProtocol, where the one or more Protocol Selection Rules are based onDICOM parameter BodyPartExamined, DICOM parameter Modality, DICOMparameter HasThisSliceVolumes, DICOM parameter StudyDescription andAbstract Tags from the plurality of second studies, applying the one ormore Image Set Rules to define a plurality of Image Sets from theplurality of second studies, applying the one or more ViewportAssignment Rules to assign one or more Image Sets from the plurality ofImage Sets to one or more Viewports defined in the Display Protocol,applying the one or more Style Rules to define a rendering style andrendering parameters of the one or more Viewports and displaying the oneor more Sets of Images in one or more Viewports based on one or more ofthe one or more Protocol Selection Rules, the one or more Image SetRules, the one or more Viewport Assignment Rules, and the one or moreStyle Rules, where at least one of the one or more Viewports displays apost processed rendering of an image set, where the step of displayingis carried out on a client display device.

In an embodiment of the invention, a method comprises providing a servercomputer in communication with one or more remote computers, where theserver computer includes one or more processors and an associatedmemory, where a plurality of medical diagnostic reports are stored onthe memory, where the plurality of medical diagnostic reports can beaccessed by the one or more processors based on a plurality of patientIDs, where a patient ID corresponds with one or more medical diagnosticreports from the plurality of medical diagnostic reports, the serverreceiving a patient ID from a remote computer from the one or moreremote computers, the server executing a render server program whichapplies one or more of one or more Study Selection Rules based on thepatient ID to select a Study from the plurality of medical diagnosticreports, the render server program applying one or more ProtocolSelection Rules and one or more Image Set Rules to generate a volumetricimage reconstructed from the Study, the render server defining at leastthree viewing directions for the Study based on the one or more ProtocolSelection Rules and the one or more Display Protocols, the render servergenerating at least three projection images from the volumetric image atthe at least three viewing directions based on the one or more ProtocolSelection Rules and the one or more Display Protocols, the serverselecting three or more images of the Study from the at least threeprojection images and the server sending the three or more images to theremote computer.

In an embodiment of the invention, a method comprises providing a servercomputer in communication with one or more remote computers, where theserver computer includes one or more processors and an associatedmemory, where a plurality of medical diagnostic reports are stored onthe memory, where the plurality of medical diagnostic reports can beaccessed by the one or more processors based on a plurality of patientIDs, where a patient ID corresponds with one or more medical diagnosticreports from the plurality of medical diagnostic reports, the serverreceiving a patient ID from a remote computer from the one or moreremote computers, the server executing a render server program whichapplies one or more of one or more Study Selection Rules based on thepatient ID to select a Study from the plurality of medical diagnosticreports, the render server program applying one or more ProtocolSelection Rules and one or more Image Set Rules to generate a volumetricimage reconstructed from the Study, the render server defining at leastthree viewing directions for the Study based on the one or more ProtocolSelection Rules and the one or more Display Protocols, the render servergenerating at least three projection images from the volumetric image atthe at least three viewing directions based on the one or more ProtocolSelection Rules and the one or more Display Protocols, the serverselecting three or more images of the Study from the at least threeprojection images and the server sending the three or more images to theremote computer, further comprising displaying a video comprising thethree or more images.

In an embodiment of the invention, a method comprises providing a servercomputer in communication with one or more remote computers, where theserver computer includes one or more processors and an associatedmemory, where a plurality of medical diagnostic reports are stored onthe memory, where the plurality of medical diagnostic reports can beaccessed by the one or more processors based on a plurality of patientIDs, where a patient ID corresponds with one or more medical diagnosticreports selected from the plurality of medical diagnostic reports, theserver receiving a patient ID from a remote computer from the one ormore remote computers, the server executing a render server programwhich applies one or more of one or more Study Selection Rules based onthe patient ID to select a first Study of the plurality of medicaldiagnostic reports and one or more of one or more Study Selection Rulesbased on the first Study to select a second Study of the plurality ofmedical diagnostic reports, the render server program applying one ormore Protocol Selection Rules and one or more Image Set Rules togenerate a first volumetric image reconstructed from the first Study,the render server program defining at least three viewing directions forthe first Study based on the one or more Protocol Selection Rules andthe one or more Display Protocols, the render server program generatingat least three first projection images from the first volumetric imageat the at least three viewing directions based on the one or moreProtocol Selection Rules and the one or more Display Protocols, therender server program selecting three or more images from the at leastthree first projection images which correspond with three or moreviewing directions to form a first Set of Images and one or both therender and the render program sending the first Set of Images to theremote computer.

In an embodiment of the invention, a method comprises providing a servercomputer in communication with one or more remote computers, where theserver computer includes one or more processors and an associatedmemory, where a plurality of medical diagnostic reports are stored onthe memory, where the plurality of medical diagnostic reports can beaccessed by the one or more processors based on a plurality of patientIDs, where a patient ID corresponds with one or more medical diagnosticreports selected from the plurality of medical diagnostic reports, theserver receiving a patient ID from a remote computer from the one ormore remote computers, the server executing a render server programwhich applies one or more of one or more Study Selection Rules based onthe patient ID to select a first Study of the plurality of medicaldiagnostic reports and one or more of one or more Study Selection Rulesbased on the first Study to select a second Study of the plurality ofmedical diagnostic reports, the render server program applying one ormore Protocol Selection Rules and one or more Image Set Rules togenerate a first volumetric image reconstructed from the first Study,the render server program defining at least three viewing directions forthe first Study based on the one or more Protocol Selection Rules andthe one or more Display Protocols, the render server program generatingat least three first projection images from the first volumetric imageat the at least three viewing directions based on the one or moreProtocol Selection Rules and the one or more Display Protocols, therender server program selecting three or more images from the at leastthree first projection images which correspond with three or moreviewing directions to form a first Set of Images, where one or moreProtocol Selection Rules are used to select a viewing direction thatidentifies a microcalcification, an obstruction, that amicrocalcification includes two or more microcalcifications, that anobstruction includes a microcalcification and an obstruction, that anobstruction includes two or more obstructions, a microcalcificationusing direct comparison and an obstruction using direct comparison, andone or both the render and the render program sending the first Set ofImages to the remote computer.

In an embodiment of the invention, a method comprises providing a servercomputer in communication with one or more remote computers, where theserver computer includes one or more processors and an associatedmemory, where a plurality of medical diagnostic reports are stored onthe memory, where the plurality of medical diagnostic reports can beaccessed by the one or more processors based on a plurality of patientIDs, where a patient ID corresponds with one or more medical diagnosticreports selected from the plurality of medical diagnostic reports, theserver receiving a patient ID from a remote computer from the one ormore remote computers, the server executing a render server programwhich applies one or more of one or more Study Selection Rules based onthe patient ID to select a first Study of the plurality of medicaldiagnostic reports and one or more of one or more Study Selection Rulesbased on the first Study to select a second Study of the plurality ofmedical diagnostic reports, the render server program applying one ormore Protocol Selection Rules and one or more Image Set Rules togenerate a first volumetric image reconstructed from the first Study,the render server program defining at least three viewing directions forthe first Study based on the one or more Protocol Selection Rules andthe one or more Display Protocols, the render server program generatingat least three first projection images from the first volumetric imageat the at least three viewing directions based on the one or moreProtocol Selection Rules and the one or more Display Protocols, therender server program selecting three or more images from the at leastthree first projection images which correspond with three or moreviewing directions to form a first Set of Images where one or moreProtocol Selection Rules are used to select a viewing direction thatimproves identification of a first projection image, identification of amicrocalcification, identification of an obstruction, resolution of twomicrocalcifications, resolution of a microcalcification and anobstruction, resolution of two obstructions, direct comparison of amicrocalcification and direct comparison of an obstruction, and one orboth the render and the render program sending the first Set of Imagesto the remote computer.

In an embodiment of the invention, a method comprises providing a servercomputer in communication with one or more remote computers, where theserver computer includes one or more processors and an associatedmemory, where a plurality of medical diagnostic reports are stored onthe memory, where the plurality of medical diagnostic reports can beaccessed by the one or more processors based on a plurality of patientIDs, where a patient ID corresponds with one or more medical diagnosticreports selected from the plurality of medical diagnostic reports, theserver receiving a patient ID from a remote computer from the one ormore remote computers, the server executing a render server programwhich applies one or more of one or more Study Selection Rules based onthe patient ID to select a first Study of the plurality of medicaldiagnostic reports, where the first Study is a Digital BreastTomosynthesis scan and one or more of one or more Study Selection Rulesbased on the first Study to select a second Study of the plurality ofmedical diagnostic reports, where the second Study is a Digital BreastTomosynthesis scan corresponding to the first Study, the render serverprogram applying one or more Protocol Selection Rules and one or moreImage Set Rules to generate a first volumetric image reconstructed fromthe first Study, the render server program defining at least threeviewing directions for the first Study based on the one or more ProtocolSelection Rules and the one or more Display Protocols, the render serverprogram generating at least three first projection images from the firstvolumetric image at the at least three viewing directions based on theone or more Protocol Selection Rules and the one or more DisplayProtocols, the render server program selecting three or more images fromthe at least three first projection images which correspond with threeor more viewing directions to form a first Set of Images, where one ormore Protocol Selection Rules are used to select a viewing directionthat identifies a microcalcification, an obstruction, that amicrocalcification includes two or more microcalcifications, that anobstruction includes a microcalcification and an obstruction, that anobstruction includes two or more obstructions, a microcalcificationusing direct comparison and an obstruction using direct comparison, andone or both the render and the render program sending the first Set ofImages to the remote computer.

In an embodiment of the invention, a method comprises providing a servercomputer in communication with one or more remote computers, where theserver computer includes one or more processors and an associatedmemory, where a plurality of medical diagnostic reports are stored onthe memory, where the plurality of medical diagnostic reports can beaccessed by the one or more processors based on a plurality of patientIDs, where a patient ID corresponds with one or more medical diagnosticreports selected from the plurality of medical diagnostic reports, theserver receiving a patient ID from a remote computer from the one ormore remote computers, the server executing a render server programwhich applies one or more of one or more Study Selection Rules based onthe patient ID to select a first Study of the plurality of medicaldiagnostic reports, where the first Study is a first volumetric imagereconstructed from a Digital Breast Tomosynthesis scan and one or moreof one or more Study Selection Rules based on the first Study to one orboth select and generate a second Study of the plurality of medicaldiagnostic reports, where the second Study is a second volumetric imagereconstructed Digital Breast Tomosynthesis scan, where the second Studyis a corresponding tissue to the first Study, the render server programdefining at least three viewing directions for the first Study based onthe one or more Protocol Selection Rules and the one or more DisplayProtocols, the render server program generating at least three firstprojection images from the first volumetric image at the at least threeviewing directions based on the one or more Protocol Selection Rules andthe one or more Display Protocols, the render server program selectingthree or more images from the at least three first projection imageswhich correspond with three or more viewing directions to form a firstSet of Images, where one or more Protocol Selection Rules are used toselect a viewing direction that identifies a microcalcification, anobstruction, that a microcalcification includes two or moremicrocalcifications, that an obstruction includes a microcalcificationand an obstruction, that an obstruction includes two or moreobstructions, a microcalcification using direct comparison and anobstruction using direct comparison, and one or both the render and therender program sending the first Set of Images to the remote computer.

In an embodiment of the invention, a method comprises providing a servercomputer in communication with one or more remote computers, where theserver computer includes one or more processors and an associatedmemory, where a plurality of medical diagnostic reports are stored onthe memory, where the plurality of medical diagnostic reports can beaccessed by the one or more processors based on a plurality of patientIDs, where a patient ID corresponds with one or more medical diagnosticreports selected from the plurality of medical diagnostic reports, theserver receiving a patient ID from a remote computer from the one ormore remote computers, the server executing a render server programwhich applies one or more of one or more Study Selection Rules based onthe patient ID to select a first Study of the plurality of medicaldiagnostic reports and one or more of one or more Study Selection Rulesbased on the first Study to select a second Study of the plurality ofmedical diagnostic reports, the render server program applying one ormore Protocol Selection Rules and one or more Image Set Rules togenerate a first volumetric image reconstructed from the first Study,the render server program defining at least three viewing directions forthe first Study based on the one or more Protocol Selection Rules andthe one or more Display Protocols, the render server program generatingat least three first projection images from the first volumetric imageat the at least three viewing directions based on the one or moreProtocol Selection Rules and the one or more Display Protocols, therender server program selecting three or more images from the at leastthree first projection images which correspond with three or moreviewing directions to form a first Set of Images, where one or moreProtocol Selection Rules are used to select a viewing direction thatidentifies a microcalcification, an obstruction, that amicrocalcification includes two or more microcalcifications, that anobstruction includes a microcalcification and an obstruction, that anobstruction includes two or more obstructions, a microcalcificationusing direct comparison and an obstruction using direct comparison, andone or both the render and the render program sending the first Set ofImages to the remote computer, where the first Set of Images aredisplayed as a video.

In an embodiment of the invention, a method comprises providing a servercomputer in communication with one or more remote computers, where theserver computer includes one or more processors and an associatedmemory, where a plurality of medical diagnostic reports are stored onthe memory, where the plurality of medical diagnostic reports can beaccessed by the one or more processors based on a plurality of patientIDs, where a patient ID corresponds with one or more medical diagnosticreports selected from the plurality of medical diagnostic reports, theserver receiving a patient ID from a remote computer from the one ormore remote computers, the server executing a render server programwhich applies one or more of one or more Study Selection Rules based onthe patient ID to select a first Study of the plurality of medicaldiagnostic reports and one or more of one or more Study Selection Rulesbased on the first Study to select a second Study of the plurality ofmedical diagnostic reports, the render server program applying one ormore Protocol Selection Rules and one or more Image Set Rules togenerate a first volumetric image reconstructed from the first Study,the render server program defining at least three viewing directions forthe first Study based on the one or more Protocol Selection Rules andthe one or more Display Protocols, the render server program generatingat least three first projection images from the first volumetric imageat the at least three viewing directions based on the one or moreProtocol Selection Rules and the one or more Display Protocols, therender server program selecting three or more images from the at leastthree first projection images which correspond with three or moreviewing directions to form a first Set of Images, where one or moreProtocol Selection Rules are used to select a viewing direction thatidentifies a microcalcification, an obstruction, that amicrocalcification includes two or more microcalcifications, that anobstruction includes a microcalcification and an obstruction, that anobstruction includes two or more obstructions, a microcalcificationusing direct comparison and an obstruction using direct comparison, andone or both the render and the render program sending the first Set ofImages to the remote computer, where the first Set of Images aredisplayed as a video, where the video displays a dynamic comparison.

In an embodiment of the invention, a method comprises providing a servercomputer in communication with one or more remote computers, where theserver computer includes one or more processors and an associatedmemory, where a plurality of medical diagnostic reports are stored onthe memory, where the plurality of medical diagnostic reports can beaccessed by the one or more processors based on a plurality of patientIDs, where a patient ID corresponds with one or more medical diagnosticreports selected from the plurality of medical diagnostic reports, theserver receiving a patient ID from a remote computer from the one ormore remote computers, the server executing a render server programwhich applies one or more of one or more Study Selection Rules based onthe patient ID to select a first Study of the plurality of medicaldiagnostic reports and one or more of one or more Study Selection Rulesbased on the first Study to select a second Study of the plurality ofmedical diagnostic reports, the render server program applying one ormore Protocol Selection Rules and one or more Image Set Rules togenerate a first volumetric image reconstructed from the first Study,the render server program defining at least three viewing directions forthe first Study based on the one or more Protocol Selection Rules andthe one or more Display Protocols, the render server program generatingat least three first projection images from the first volumetric imageat the at least three viewing directions based on the one or moreProtocol Selection Rules and the one or more Display Protocols, wherethe viewing directions are selected according to a periodic continuousmathematical function, the render server program selecting three or moreimages from the at least three first projection images which correspondwith three or more viewing directions to form a first Set of Images,where one or more Protocol Selection Rules are used to select a viewingdirection that identifies a microcalcification, an obstruction, that amicrocalcification includes two or more microcalcifications, that anobstruction includes a microcalcification and an obstruction, that anobstruction includes two or more obstructions, a microcalcificationusing direct comparison and an obstruction using direct comparison, andone or both the render and the render program sending the first Set ofImages to the remote computer.

In an embodiment of the invention, a method comprises providing a servercomputer in communication with one or more remote computers, where theserver computer includes one or more processors and an associatedmemory, where a plurality of medical diagnostic reports are stored onthe memory, where the plurality of medical diagnostic reports can beaccessed by the one or more processors based on a plurality of patientIDs, where a patient ID corresponds with one or more medical diagnosticreports selected from the plurality of medical diagnostic reports, theserver receiving a patient ID from a remote computer from the one ormore remote computers, the server executing a render server programwhich applies one or more of one or more Study Selection Rules based onthe patient ID to select a first Study of the plurality of medicaldiagnostic reports and one or more of one or more Study Selection Rulesbased on the first Study to select a second Study of the plurality ofmedical diagnostic reports, the render server program applying one ormore Protocol Selection Rules and one or more Image Set Rules togenerate a first volumetric image reconstructed from the first Study,the render server program defining at least three viewing directions forthe first Study based on the one or more Protocol Selection Rules andthe one or more Display Protocols, the render server program generatingat least three first projection images from the first volumetric imageat the at least three viewing directions based on the one or moreProtocol Selection Rules and the one or more Display Protocols, wherethe viewing directions are selected according to a periodic continuousmathematical function, where the at least three projection images aregenerated from viewing directions spanning one period of the periodiccontinuous mathematical function, the render server program selectingthree or more images from the at least three first projection imageswhich correspond with three or more viewing directions to form a firstSet of Images, where one or more Protocol Selection Rules are used toselect a viewing direction that identifies a microcalcification, anobstruction, that a microcalcification includes two or moremicrocalcifications, that an obstruction includes a microcalcificationand an obstruction, that an obstruction includes two or moreobstructions, a microcalcification using direct comparison and anobstruction using direct comparison, and one or both the render and therender program sending the first Set of Images to the remote computer.

In an embodiment of the invention, a method comprises providing a servercomputer in communication with one or more remote computers, where theserver computer includes one or more processors and an associatedmemory, where a plurality of medical diagnostic reports are stored onthe memory, where the plurality of medical diagnostic reports can beaccessed by the one or more processors based on a plurality of patientIDs, where a patient ID corresponds with one or more medical diagnosticreports selected from the plurality of medical diagnostic reports, theserver receiving a patient ID from a remote computer from the one ormore remote computers, the server executing a render server programwhich applies one or more of one or more Study Selection Rules based onthe patient ID to select a first Study of the plurality of medicaldiagnostic reports and one or more of one or more Study Selection Rulesbased on the first Study to select a second Study of the plurality ofmedical diagnostic reports, the render server program applying one ormore Protocol Selection Rules and one or more Image Set Rules togenerate a first volumetric image reconstructed from the first Study,the render server program defining at least three viewing directions forthe first Study based on the one or more Protocol Selection Rules andthe one or more Display Protocols, the render server program generatingat least three first projection images from the first volumetric imageat the at least three viewing directions based on the one or moreProtocol Selection Rules and the one or more Display Protocols, therender server program selecting three or more images from the at leastthree first projection images which correspond with three or moreviewing directions to form a first Set of Images, where one or moreProtocol Selection Rules are used to select a viewing direction thatidentifies a microcalcification, an obstruction, that amicrocalcification includes two or more microcalcifications, that anobstruction includes a microcalcification and an obstruction, that anobstruction includes two or more obstructions, a microcalcificationusing direct comparison and an obstruction using direct comparison, andone or both the render and the render program sending the first Set ofImages to the remote computer, where the remote computer stores thefirst Set of Images.

In an embodiment of the invention, a method comprises providing a servercomputer in communication with one or more remote computers, where theserver computer includes one or more processors and an associatedmemory, where a plurality of medical diagnostic reports are stored onthe memory, where the plurality of medical diagnostic reports can beaccessed by the one or more processors based on a plurality of patientIDs, where a patient ID corresponds with one or more medical diagnosticreports selected from the plurality of medical diagnostic reports, theserver receiving a patient ID from a remote computer from the one ormore remote computers, the server executing a render server programwhich applies one or more of one or more Study Selection Rules based onthe patient ID to select a first Study of the plurality of medicaldiagnostic reports and one or more of one or more Study Selection Rulesbased on the first Study to select a second Study of the plurality ofmedical diagnostic reports, the render server program applying one ormore Protocol Selection Rules and one or more Image Set Rules togenerate a first volumetric image reconstructed from the first Study,the render server program defining at least three viewing directions forthe first Study based on the one or more Protocol Selection Rules andthe one or more Display Protocols, the render server program generatingat least three first projection images from the first volumetric imageat the at least three viewing directions based on the one or moreProtocol Selection Rules and the one or more Display Protocols, therender server program selecting three or more images from the at leastthree first projection images which correspond with three or moreviewing directions to form a first Set of Images, where one or moreProtocol Selection Rules are used to select a viewing direction thatidentifies a microcalcification, an obstruction, that amicrocalcification includes two or more microcalcifications, that anobstruction includes a microcalcification and an obstruction, that anobstruction includes two or more obstructions, a microcalcificationusing direct comparison and an obstruction using direct comparison, andone or both the render and the render program sending the first Set ofImages and instructions to display the first Set of Images to the remotecomputer.

In an embodiment of the invention, a method comprises providing a servercomputer in communication with one or more remote computers, where theserver computer includes one or more processors and an associatedmemory, where a plurality of medical diagnostic reports are stored onthe memory, where the plurality of medical diagnostic reports can beaccessed by the one or more processors based on a plurality of patientIDs, where a patient ID corresponds with one or more medical diagnosticreports selected from the plurality of medical diagnostic reports, theserver receiving a patient ID from a remote computer from the one ormore remote computers, the server executing a render server programwhich applies one or more of one or more Study Selection Rules based onthe patient ID to select a first Study of the plurality of medicaldiagnostic reports and one or more of one or more Study Selection Rulesbased on the first Study to select a second Study of the plurality ofmedical diagnostic reports, the render server program applying one ormore Protocol Selection Rules and one or more Image Set Rules togenerate a first volumetric image reconstructed from the first Study,the render server program defining at least three viewing directions forthe first Study based on the one or more Protocol Selection Rules andthe one or more Display Protocols, the render server program generatingat least three first projection images from the first volumetric imageat the at least three viewing directions based on the one or moreProtocol Selection Rules and the one or more Display Protocols, therender server program selecting three or more images from the at leastthree first projection images which correspond with three or moreviewing directions to form a first Set of Images, the render serverprogram applying one or more Protocol Selection Rules and one or moreImage Set Rules to generate a second volumetric image reconstructed fromthe second Study, the render server program using the three or moreviewing directions to generate three or more second projection imagesfrom the second volumetric image, where the three or more secondprojection images form a second Set of Images and the render programsending the first Set of Images and the second Set of Images to theremote computer.

In an embodiment of the invention, a method comprises providing a servercomputer in communication with one or more remote computers, where theserver computer includes one or more processors and an associatedmemory, where a plurality of medical diagnostic reports are stored onthe memory, where the plurality of medical diagnostic reports can beaccessed by the one or more processors based on a plurality of patientIDs, where a patient ID corresponds with one or more medical diagnosticreports selected from the plurality of medical diagnostic reports, theserver receiving a patient ID from a remote computer from the one ormore remote computers, the server executing a render server programwhich applies one or more of one or more Study Selection Rules based onthe patient ID to select a first Study of the plurality of medicaldiagnostic reports and one or more of one or more Study Selection Rulesbased on the first Study to select a second Study of the plurality ofmedical diagnostic reports, the render server program applying one ormore Protocol Selection Rules and one or more Image Set Rules togenerate a first volumetric image reconstructed from the first Study,the render server program defining at least three viewing directions forthe first Study based on the one or more Protocol Selection Rules andthe one or more Display Protocols, the render server program generatingat least three first projection images from the first volumetric imageat the at least three viewing directions based on the one or moreProtocol Selection Rules and the one or more Display Protocols, therender server program selecting three or more images from the at leastthree first projection images which correspond with three or moreviewing directions to form a first Set of Images, the render serverprogram applying one or more Protocol Selection Rules and one or moreImage Set Rules to generate a second volumetric image reconstructed fromthe second Study, the render server program using the three or moreviewing directions to generate three or more second projection imagesfrom the second volumetric image, where one or more Protocol SelectionRules are used to select a viewing direction that identifies amicrocalcification, an obstruction, that a microcalcification includestwo or more microcalcifications, that an obstruction includes amicrocalcification and an obstruction, that an obstruction includes twoor more obstructions, a microcalcification using direct comparison andan obstruction using direct comparison, where the three or more secondprojection images form a second Set of Images and the render programsending the first Set of Images and the second Set of Images to theremote computer.

In an embodiment of the invention, a method comprises providing a servercomputer in communication with one or more remote computers, where theserver computer includes one or more processors and an associatedmemory, where a plurality of medical diagnostic reports are stored onthe memory, where the plurality of medical diagnostic reports can beaccessed by the one or more processors based on a plurality of patientIDs, where a patient ID corresponds with one or more medical diagnosticreports selected from the plurality of medical diagnostic reports, theserver receiving a patient ID from a remote computer from the one ormore remote computers, the server executing a render server programwhich applies one or more of one or more Study Selection Rules based onthe patient ID to select a first Study of the plurality of medicaldiagnostic reports and one or more of one or more Study Selection Rulesbased on the first Study to select a second Study of the plurality ofmedical diagnostic reports, the render server program applying one ormore Protocol Selection Rules and one or more Image Set Rules togenerate a first volumetric image reconstructed from the first Study,the render server program defining at least three viewing directions forthe first Study based on the one or more Protocol Selection Rules andthe one or more Display Protocols, the render server program generatingat least three first projection images from the first volumetric imageat the at least three viewing directions based on the one or moreProtocol Selection Rules and the one or more Display Protocols, therender server program selecting three or more images from the at leastthree first projection images which correspond with three or moreviewing directions to form a first Set of Images, the render serverprogram applying one or more Protocol Selection Rules and one or moreImage Set Rules to generate a second volumetric image reconstructed fromthe second Study, the render server program using the three or moreviewing directions to generate three or more second projection imagesfrom the second volumetric image, where one or more Protocol SelectionRules are used to select a viewing direction selected from the first Setof Images that improves identification of an initial projection image, aviewing direction selected from the first Set of Images that improvescomparison of an initial projection image and a subsequent projectionimage, a viewing direction selected from the first Set of Images thatimproves identification of a microcalcification, a viewing directionselected from the first Set of Images that improves identification of anobstruction, a viewing direction selected from the first Set of Imagesthat improves resolution of two microcalcifications, a viewing directionselected from the first Set of Images that improves resolution of amicrocalcification and an obstruction, a viewing direction selected fromthe first Set of Images that improves resolution of two obstructions, aviewing direction selected from the first Set of Images that improvesdirect comparison with an initial projection image and a subsequentprojection image, a viewing direction selected from the first Set ofImages that improves direct comparison of a microcalcification and aviewing direction selected from the first Set of Images that improvesdirect comparison of an obstruction, where the three or more secondprojection images form a second Set of Images and the render programsending the first Set of Images and the second Set of Images to theremote computer.

In an embodiment of the invention, a method comprises providing a servercomputer in communication with one or more remote computers, where theserver computer includes one or more processors and an associatedmemory, where a plurality of medical diagnostic reports are stored onthe memory, where the plurality of medical diagnostic reports can beaccessed by the one or more processors based on a plurality of patientIDs, where a patient ID corresponds with one or more medical diagnosticreports selected from the plurality of medical diagnostic reports, theserver receiving a patient ID from a remote computer from the one ormore remote computers, the server executing a render server programwhich applies one or more of one or more Study Selection Rules based onthe patient ID to select a first Study of the plurality of medicaldiagnostic reports, where the first Study Study is a Digital BreastTomosynthesis scan and one or more of one or more Study Selection Rulesbased on the first Study to select a second Study of the plurality ofmedical diagnostic reports, where the second Study Study is acomplementary Digital Breast Tomosynthesis scan of the first Study, therender server program applying one or more Protocol Selection Rules andone or more Image Set Rules to generate a first volumetric imagereconstructed from the first Study, the render server program definingat least three viewing directions for the first Study based on the oneor more Protocol Selection Rules and the one or more Display Protocols,the render server program generating at least three first projectionimages from the first volumetric image at the at least three viewingdirections based on the one or more Protocol Selection Rules and the oneor more Display Protocols, the render server program selecting three ormore images from the at least three first projection images whichcorrespond with three or more viewing directions to form a first Set ofImages, the render server program applying one or more ProtocolSelection Rules and one or more Image Set Rules to generate a secondvolumetric image reconstructed from the second Study, the render serverprogram using the three or more viewing directions to generate three ormore second projection images from the second volumetric image, wherethe three or more second projection images form a second Set of Imagesand the render program sending the first Set of Images and the secondSet of Images to the remote computer.

In an embodiment of the invention, a method comprises providing a servercomputer in communication with one or more remote computers, where theserver computer includes one or more processors and an associatedmemory, where a plurality of medical diagnostic reports are stored onthe memory, where the plurality of medical diagnostic reports can beaccessed by the one or more processors based on a plurality of patientIDs, where a patient ID corresponds with one or more medical diagnosticreports selected from the plurality of medical diagnostic reports, theserver receiving a patient ID from a remote computer from the one ormore remote computers, the server executing a render server programwhich applies one or more of one or more Study Selection Rules based onthe patient ID to select a first Study of the plurality of medicaldiagnostic reports and one or more of one or more Study Selection Rulesbased on the first Study to select a second Study of the plurality ofmedical diagnostic reports, the render server program applying one ormore Protocol Selection Rules and one or more Image Set Rules togenerate a first volumetric image reconstructed from the first Study,the render server program defining at least three viewing directions forthe first Study based on the one or more Protocol Selection Rules andthe one or more Display Protocols, the render server program generatingat least three first projection images from the first volumetric imageat the at least three viewing directions based on the one or moreProtocol Selection Rules and the one or more Display Protocols, therender server program selecting three or more images from the at leastthree first projection images which correspond with three or moreviewing directions to form a first Set of Images, the render serverprogram applying one or more Protocol Selection Rules and one or moreImage Set Rules to generate a second volumetric image reconstructed fromthe second Study, the render server program using the three or moreviewing directions to generate three or more second projection imagesfrom the second volumetric image, where the three or more secondprojection images form a second Set of Images and the render programsending the first Set of Images and the second Set of Images to theremote computer, where one or both the first Set of Images and thesecond Set of Images are displayed as a video.

In an embodiment of the invention, a method comprises providing a servercomputer in communication with one or more remote computers, where theserver computer includes one or more processors and an associatedmemory, where a plurality of medical diagnostic reports are stored onthe memory, where the plurality of medical diagnostic reports can beaccessed by the one or more processors based on a plurality of patientIDs, where a patient ID corresponds with one or more medical diagnosticreports selected from the plurality of medical diagnostic reports, theserver receiving a patient ID from a remote computer from the one ormore remote computers, the server executing a render server programwhich applies one or more of one or more Study Selection Rules based onthe patient ID to select a first Study of the plurality of medicaldiagnostic reports and one or more of one or more Study Selection Rulesbased on the first Study to select a second Study of the plurality ofmedical diagnostic reports, the render server program applying one ormore Protocol Selection Rules and one or more Image Set Rules togenerate a first volumetric image reconstructed from the first Study,the render server program defining at least three viewing directions forthe first Study based on the one or more Protocol Selection Rules andthe one or more Display Protocols, the render server program generatingat least three first projection images from the first volumetric imageat the at least three viewing directions based on the one or moreProtocol Selection Rules and the one or more Display Protocols, therender server program selecting three or more images from the at leastthree first projection images which correspond with three or moreviewing directions to form a first Set of Images, the render serverprogram applying one or more Protocol Selection Rules and one or moreImage Set Rules to generate a second volumetric image reconstructed fromthe second Study, the render server program using the three or moreviewing directions to generate three or more second projection imagesfrom the second volumetric image, where the three or more secondprojection images form a second Set of Images and the render programsending the first Set of Images and the second Set of Images to theremote computer, where one or both the first Set of Images and thesecond Set of Images are displayed as a video, where the video displaysa dynamic comparison.

In an embodiment of the invention, a method comprises providing a servercomputer in communication with one or more remote computers, where theserver computer includes one or more processors and an associatedmemory, where a plurality of medical diagnostic reports are stored onthe memory, where the plurality of medical diagnostic reports can beaccessed by the one or more processors based on a plurality of patientIDs, where a patient ID corresponds with one or more medical diagnosticreports selected from the plurality of medical diagnostic reports, theserver receiving a patient ID from a remote computer from the one ormore remote computers, the server executing a render server programwhich applies one or more of one or more Study Selection Rules based onthe patient ID to select a first Study of the plurality of medicaldiagnostic reports and one or more of one or more Study Selection Rulesbased on the first Study to select a second Study of the plurality ofmedical diagnostic reports, the render server program applying one ormore Protocol Selection Rules and one or more Image Set Rules togenerate a first volumetric image reconstructed from the first Study,the render server program defining at least three viewing directions forthe first Study based on the one or more Protocol Selection Rules andthe one or more Display Protocols, the render server program generatingat least three first projection images from the first volumetric imageat the at least three viewing directions based on the one or moreProtocol Selection Rules and the one or more Display Protocols, wherethe at least three viewing directions are selected according to aperiodic continuous mathematical function, the render server programselecting three or more images from the at least three first projectionimages which correspond with three or more viewing directions to form afirst Set of Images, the render server program applying one or moreProtocol Selection Rules and one or more Image Set Rules to generate asecond volumetric image reconstructed from the second Study, the renderserver program using the three or more viewing directions to generatethree or more second projection images from the second volumetric image,where the three or more second projection images form a second Set ofImages and the render program sending the first Set of Images and thesecond Set of Images to the remote computer.

In an embodiment of the invention, a method comprises providing a servercomputer in communication with one or more remote computers, where theserver computer includes one or more processors and an associatedmemory, where a plurality of medical diagnostic reports are stored onthe memory, where the plurality of medical diagnostic reports can beaccessed by the one or more processors based on a plurality of patientIDs, where a patient ID corresponds with one or more medical diagnosticreports selected from the plurality of medical diagnostic reports, theserver receiving a patient ID from a remote computer from the one ormore remote computers, the server executing a render server programwhich applies one or more of one or more Study Selection Rules based onthe patient ID to select a first Study of the plurality of medicaldiagnostic reports and one or more of one or more Study Selection Rulesbased on the first Study to select a second Study of the plurality ofmedical diagnostic reports, the render server program applying one ormore Protocol Selection Rules and one or more Image Set Rules togenerate a first volumetric image reconstructed from the first Study,the render server program defining at least three viewing directions forthe first Study based on the one or more Protocol Selection Rules andthe one or more Display Protocols, the render server program generatingat least three first projection images from the first volumetric imageat the at least three viewing directions based on the one or moreProtocol Selection Rules and the one or more Display Protocols, wherethe at least three viewing directions are selected according to aperiodic continuous mathematical function, where the at least threeviewing directions span one period of the periodic continuousmathematical function, the render server program selecting three or moreimages from the at least three first projection images which correspondwith three or more viewing directions to form a first Set of Images, therender server program applying one or more Protocol Selection Rules andone or more Image Set Rules to generate a second volumetric imagereconstructed from the second Study, the render server program using thethree or more viewing directions to generate three or more secondprojection images from the second volumetric image, where the three ormore second projection images form a second Set of Images and the renderprogram sending the first Set of Images and the second Set of Images tothe remote computer.

In an embodiment of the invention, a method comprises providing a servercomputer in communication with one or more remote computers, where theserver computer includes one or more processors and an associatedmemory, where a plurality of medical diagnostic reports are stored onthe memory, where the plurality of medical diagnostic reports can beaccessed by the one or more processors based on a plurality of patientIDs, where a patient ID corresponds with one or more medical diagnosticreports selected from the plurality of medical diagnostic reports, theserver receiving a patient ID from a remote computer from the one ormore remote computers, the server executing a render server programwhich applies one or more of one or more Study Selection Rules based onthe patient ID to select a first Study of the plurality of medicaldiagnostic reports and one or more of one or more Study Selection Rulesbased on the first Study to select a second Study of the plurality ofmedical diagnostic reports, the render server program applying one ormore Protocol Selection Rules and one or more Image Set Rules togenerate a first volumetric image reconstructed from the first Study,the render server program defining at least three viewing directions forthe first Study based on the one or more Protocol Selection Rules andthe one or more Display Protocols, the render server program generatingat least three first projection images from the first volumetric imageat the at least three viewing directions based on the one or moreProtocol Selection Rules and the one or more Display Protocols, therender server program selecting three or more images from the at leastthree first projection images which correspond with three or moreviewing directions to form a first Set of Images, the render serverprogram applying one or more Protocol Selection Rules and one or moreImage Set Rules to generate a second volumetric image reconstructed fromthe second Study, the render server program using the three or moreviewing directions to generate three or more second projection imagesfrom the second volumetric image, where the three or more secondprojection images form a second Set of Images and the render programsending the first Set of Images and the second Set of Images to theremote computer, where the remote computer stores one or both the firstSet of Images and the second Set of Images.

In an embodiment of the invention, a method comprises providing a servercomputer in communication with one or more remote computers, where theserver computer includes one or more processors and an associatedmemory, where a plurality of medical diagnostic reports are stored onthe memory, where the plurality of medical diagnostic reports can beaccessed by the one or more processors based on a plurality of patientIDs, where a patient ID corresponds with one or more medical diagnosticreports selected from the plurality of medical diagnostic reports, theserver receiving a patient ID from a remote computer from the one ormore remote computers, the server executing a render server programwhich applies one or more of one or more Study Selection Rules based onthe patient ID to select a first Study of the plurality of medicaldiagnostic reports and one or more of one or more Study Selection Rulesbased on the first Study to select a second Study of the plurality ofmedical diagnostic reports, the render server program applying one ormore Protocol Selection Rules and one or more Image Set Rules togenerate a first volumetric image reconstructed from the first Study,the render server program defining at least three viewing directions forthe first Study based on the one or more Protocol Selection Rules andthe one or more Display Protocols, the render server program generatingat least three first projection images from the first volumetric imageat the at least three viewing directions based on the one or moreProtocol Selection Rules and the one or more Display Protocols, therender server program selecting three or more images from the at leastthree first projection images which correspond with three or moreviewing directions to form a first Set of Images, the render serverprogram applying one or more Protocol Selection Rules and one or moreImage Set Rules to generate a second volumetric image reconstructed fromthe second Study, the render server program using the three or moreviewing directions to generate three or more second projection imagesfrom the second volumetric image, where the three or more secondprojection images form a second Set of Images and the render programsending the first Set of Images and the second Set of Images andinstructions to one or both display the first Set of Images and thesecond Set of Images to the remote computer.

In an embodiment of the invention, a method comprises providing a servercomputer in communication with one or more remote computers, where theserver computer includes one or more processors and an associatedmemory, where a plurality of medical diagnostic reports are stored onthe memory, where the plurality of medical diagnostic reports can beaccessed by the one or more processors based on a plurality of patientIDs, where a patient ID corresponds with one or more medical diagnosticreports selected from the plurality of medical diagnostic reports, theserver receiving a patient ID from a remote computer from the one ormore remote computers, the server executing a render server programwhich applies one or more of one or more Study Selection Rules based onthe patient ID to select a first Study of the plurality of medicaldiagnostic reports and one or more of one or more Study Selection Rulesbased on the first Study to select a second Study of the plurality ofmedical diagnostic reports, where the first Study is a firstreconstructed volumetric image, the render server program defining atleast three viewing directions for the first Study based on the one ormore Protocol Selection Rules and the one or more Display Protocols, therender server program generating at least three first projection imagesfrom the first volumetric image at the at least three viewing directionsbased on the one or more Protocol Selection Rules and the one or moreDisplay Protocols, the render server program selecting three or moreimages from the at least three first projection images which correspondwith three or more viewing directions to form a first Set of Images, therender server program applying one or more Protocol Selection Rules andone or more Image Set Rules to one or both select and generate a secondvolumetric image reconstructed from the second Study, the render serverprogram using the three or more viewing directions to generate three ormore second projection images from the second volumetric image, wherethe three or more second projection images form a second Set of Imagesand the render program sending the first Set of Images and the secondSet of Images to the remote computer.

In an embodiment of the invention, a method comprises providing a servercomputer in communication with one or more remote computers, where theserver computer includes one or more processors and an associatedmemory, where a plurality of medical diagnostic reports are stored onthe memory, where the plurality of medical diagnostic reports can beaccessed by the one or more processors based on a plurality of patientIDs, where a patient ID corresponds with one or more medical diagnosticreports selected from the plurality of medical diagnostic reports, theserver receiving a patient ID from a remote computer from the one ormore remote computers, the server executing a render server programwhich applies one or more of one or more Study Selection Rules based onthe patient ID to select a first Study of the plurality of medicaldiagnostic reports and one or more of one or more Study Selection Rulesbased on the first Study to select a second Study of the plurality ofmedical diagnostic reports, the render server program applying one ormore Protocol Selection Rules and one or more Image Set Rules togenerate a first volumetric image reconstructed from the first Study,the render server program defining at least three viewing directions forthe first Study based on the one or more Protocol Selection Rules andthe one or more Display Protocols, the render server program generatingat least three first projection images from the first volumetric imageat the at least three viewing directions based on the one or moreProtocol Selection Rules and the one or more Display Protocols, therender server program selecting three or more images from the at leastthree first projection images which correspond with three or moreviewing directions to form a first Set of Images, the render serverprogram applying one or more Protocol Selection Rules and one or moreImage Set Rules to generate a second volumetric image reconstructed fromthe second Study, the render server program using the three or moreviewing directions to generate three or more second projection imagesfrom the second volumetric image, where the three or more secondprojection images form a second Set of Images and the render programsending the first Set of Images and the second Set of Images to theremote computer, where the first Set of Images is displayed as a firstvideo and the second Set of Images is displayed as a second video.

In an embodiment of the invention, a method comprises providing a servercomputer in communication with one or more remote computers, where theserver computer includes one or more processors and an associatedmemory, where a plurality of medical diagnostic reports are stored onthe memory, where the plurality of medical diagnostic reports can beaccessed by the one or more processors based on a plurality of patientIDs, where a patient ID corresponds with one or more medical diagnosticreports selected from the plurality of medical diagnostic reports, theserver receiving a patient ID from a remote computer from the one ormore remote computers, the server executing a render server programwhich applies one or more of one or more Study Selection Rules based onthe patient ID to select a first Study of the plurality of medicaldiagnostic reports and one or more of one or more Study Selection Rulesbased on the first Study to select a second Study of the plurality ofmedical diagnostic reports, the render server program applying one ormore Protocol Selection Rules and one or more Image Set Rules togenerate a first volumetric image reconstructed from the first Study,the render server program defining at least three viewing directions forthe first Study based on the one or more Protocol Selection Rules andthe one or more Display Protocols, the render server program generatingat least three first projection images from the first volumetric imageat the at least three viewing directions based on the one or moreProtocol Selection Rules and the one or more Display Protocols, therender server program selecting three or more images from the at leastthree first projection images which correspond with three or moreviewing directions to form a first Set of Images, the render serverprogram applying one or more Protocol Selection Rules and one or moreImage Set Rules to generate a second volumetric image reconstructed fromthe second Study, the render server program using the three or moreviewing directions to generate three or more second projection imagesfrom the second volumetric image, where the three or more secondprojection images form a second Set of Images and the render programsending the first Set of Images and the second Set of Images to theremote computer, where the first Set of Images is displayed as a firstvideo and the second Set of Images is displayed as a second video, wherethe first video and the second video display a time comparison.

In an embodiment of the invention, a method comprises providing a servercomputer in communication with one or more remote computers, where theserver computer includes one or more processors and an associatedmemory, where a plurality of medical diagnostic reports are stored onthe memory, where the plurality of medical diagnostic reports can beaccessed by the one or more processors based on a plurality of patientIDs, where a patient ID corresponds with one or more medical diagnosticreports selected from the plurality of medical diagnostic reports, theserver receiving a patient ID from a remote computer from the one ormore remote computers, the server executing a render server programwhich applies one or more of one or more Study Selection Rules based onthe patient ID to select a first Study of the plurality of medicaldiagnostic reports and one or more of one or more Study Selection Rulesbased on the first Study to select a second Study of the plurality ofmedical diagnostic reports, the render server program applying one ormore Protocol Selection Rules and one or more Image Set Rules togenerate a first volumetric image reconstructed from the first Study,the render server program defining at least three viewing directions forthe first Study based on the one or more Protocol Selection Rules andthe one or more Display Protocols, the render server program generatingat least three first projection images from the first volumetric imageat the at least three viewing directions based on the one or moreProtocol Selection Rules and the one or more Display Protocols, therender server program selecting three or more images from the at leastthree first projection images which correspond with three or moreviewing directions to form a first Set of Images, the render serverprogram applying one or more Protocol Selection Rules and one or moreImage Set Rules to generate a second volumetric image reconstructed fromthe second Study, the render server program using the three or moreviewing directions to generate three or more second projection imagesfrom the second volumetric image, where the three or more secondprojection images form a second Set of Images and the render programsending the first Set of Images and the second Set of Images to theremote computer, where the first Set of Images is displayed as a firstvideo and the second Set of Images is displayed as a second video, wherethe first video and the second video display a structural comparison.

In an embodiment of the invention, a method comprises providing a remotecomputer, the remote computer selecting a Study including a plurality ofmeasured projection images, sending instructions to a host computerbased on one or more Protocol Selection Rules and one or more Image SetRules to generate a volumetric image reconstructed from the plurality ofmeasured projection images, instructing the host computer to computethree or more projection images of the volumetric image using three ormore viewing directions defined based on the one or more ProtocolSelection Rules and the one or more Display Protocols, where the threeor more viewing directions change with time, instructing the hostcomputer to send the three or more projection images to the remotecomputer, applying one or more Protocol Selection Rules with the Set ofImages to generate a Set of Images and displaying on the remote displaythe Set of Images.

In an embodiment of the invention, a method comprises for a firsttissue, selecting a first Study including a plurality of measuredprojection images, generating a primary volumetric image reconstructedfrom the first Study based on one or more Protocol Selection Rules andone or more Image Set Rules, defining three or more viewing directionsfor the first Study based on one or more Protocol Selection Rules andone or more Display Protocols, generating three or more primaryprojection images from a volumetric image based on the three or moreviewing directions, where the three or more primary projection imagesform a first Set of Images, applying the one or more Protocol SelectionRules with the first Set of Images to generate a first video of thefirst Study, for a second tissue, applying one or more Study SelectionRules to generate a second Study based on one or more DICOM parametersand one or more Abstract Tags of the first Study and one or more DICOMparameters and one or more Abstract Tags of the second Study, generatinga volumetric image reconstructed from the second Study based on the oneor more Protocol Selection Rules and one or more Image Set Rules,defining three or more equivalent viewing directions for the secondStudy based on one or more of the three or more viewing directions, theone or more Protocol Selection Rules and the one or more DisplayProtocols, generating three or more second projection images from thesecond volumetric image based on the three or more equivalent viewingdirections, where the three or more second projection images form asecond Set of Images, applying the one or more Protocol Selection Ruleswith the second Set of Images to generate a second video of the secondStudy and displaying the first video and the second video.

Described above are methods and systems for implementing a rule derivedbasis to display three or more 2-D projections of volumetric image setsincluding DBT volume sets. The foregoing description of embodiments ofthe methods, systems, and components of the present invention has beenprovided for the purposes of illustration and description. It is notintended to be exhaustive or to limit the invention to the precise formsdisclosed. Many modifications and variations will be apparent to one ofordinary skill in the relevant arts. For example, steps performed in theembodiments of the invention disclosed can be performed in alternateorders, certain steps can be omitted, and additional steps can be added.The embodiments were chosen and described in order to best explain theprinciples of the invention and its practical application, therebyenabling others skilled in the art to understand the invention forvarious embodiments and with various modifications that are suited tothe particular used contemplated. Other embodiments are possible and arecovered by the invention. Such embodiments will be apparent to personsskilled in the relevant art(s) based on the teachings contained herein.The breadth and scope of the present invention should not be limited byany of the above-described exemplary embodiments, but should be definedonly in accordance with the following claims and their equivalents.

What is claimed is:
 1. A method to display a video comprising: providinga server computer in communication with a remote computer, where theserver computer: a) receives a patient ID from the remote computer,where the patient ID corresponds with one or more medical diagnosticreports of a patient selected from a plurality of medical diagnosticreports; b) executes a render server program comprising: i) a step forapplying one or more Study Selection Rules based on the patient ID toselect a Study from the plurality of medical diagnostic reports; ii) astep for constructing from the Study a volumetric image of an anatomicalregion of the patient; iii) a step for defining at least three viewingdirections; and iv) a step for generating at least three projectionimages at the at least three viewing directions from the volumetricimage; and c) sends a video comprising the at least three projectionimages to the remote computer.
 2. The method of claim 1, where the Studyis a Digital Breast Tomosynthesis scan.
 3. The method of claim 1, whereone or more Protocol Selection Rules are used to select a viewingdirection that identifies one or both a microcalcification and anobstruction.
 4. The method of claim 1, where one or more ProtocolSelection Rules are used to select a viewing direction that improves:identification of a projection image; comparison of a projection image;identification of a microcalcification; identification of anobstruction; resolution of two microcalcifications; resolution of amicrocalcification and an obstruction; resolution of two obstructions;direct comparison with a first projection image and a second projectionimage; direct comparison of a microcalcification; and direct comparisonof an obstruction.
 5. The method of claim 1, where the video displays adynamic comparison.
 6. The method of claim 1, where the video displays adirect comparison.
 7. The method of claim 1, where the at least threeviewing directions are selected according to a periodic continuousmathematical function.
 8. The method of claim 7, where the three or moreimages are generated from viewing directions spanning one period of theperiodic continuous mathematical function.
 9. The method of claim 1,further comprising storing the video in a cache.
 10. A methodcomprising: (A) receiving at a server from a client computer a primarystudy of a patient; (B) executing on the server a server program, wherethe server program carries out: (i) a step for constructing a volumetricimage of an anatomical region of the patient from the primary study;(ii) a step for defining at least three viewing directions; (iii) a stepfor generating at least three projection images using the at least threeviewing directions; and (iv) a step for generating a video comprisingthe at least three projection images; and (C) sending the video from theserver to the client computer.
 11. The method of claim 10, where theprimary study is a Digital Breast Tomosynthesis scan.
 12. The method ofclaim 10, where one or more Protocol Selection Rules are used to selecta viewing direction that identifies: a microcalcification; anobstruction; a microcalcification that includes two or moremicrocalcifications; an obstruction that includes a microcalcificationand an obstruction; an obstruction that includes two or moreobstructions; a microcalcification using direct comparison; and anobstruction using direct comparison.
 13. The method of claim 10, whereone or more Protocol Selection Rules are used to select a viewingdirection that improves: identification of a projection image;comparison of a projection image; identification of amicrocalcification; identification of an obstruction; resolution of twomicrocalcifications; resolution of a microcalcification and anobstruction; resolution of two obstructions; direct comparison with afirst projection image and a second projection image; direct comparisonof a microcalcification; and direct comparison of an obstruction. 14.The method of claim 10, where the video displays a dynamic comparison.15. The method of claim 10, where the video displays a directcomparison.
 16. The method of claim 10, where the at least three viewingdirections are selected according to a periodic continuous mathematicalfunction.
 17. The method of claim 16, where the three or more images aregenerated from viewing directions spanning one period of the periodiccontinuous mathematical function.
 18. The method of claim 16, furthercomprising storing the video.
 19. A method comprising: (A) receiving ata server from a client computer a patient ID corresponding to a patient,the server comprising a server digital data processor, and the clientcomputer comprising a client digital data processor; (B) executing onthe server a render server program comprising: (i) a step for applyingone or more Study Selection Rules based on the patient ID to select aStudy of the patient; (ii) a step for constructing a volumetric image ofan anatomical region of the Study; (iii) a step for defining at leastthree viewing directions; (iv) a step for generating at least threeprojection images at the at least three viewing directions from thevolumetric image; (v) a step for constructing a video comprising the atleast three projection images; and (C) sending the video from the serverto the client computer.
 20. The method of claim 19, where one or moreProtocol Selection Rules are used to select a viewing direction thatidentifies: a microcalcification; an obstruction; a microcalcificationthat includes two or more microcalcifications; an obstruction thatincludes a microcalcification and an obstruction; an obstruction thatincludes two or more obstructions; a microcalcification using directcomparison; and an obstruction using direct comparison.